Dosing ketamine for pediatric procedural sedation in the emergency department

Dallimore, Daniel, Herd, David W., Short, Tim and Anderson, Brian J. (2008) Dosing ketamine for pediatric procedural sedation in the emergency department. Pediatric Emergency Care, 24 8: 529-533. doi:10.1097/PEC.0b013e318180fdb5

Author Dallimore, Daniel
Herd, David W.
Short, Tim
Anderson, Brian J.
Title Dosing ketamine for pediatric procedural sedation in the emergency department
Journal name Pediatric Emergency Care   Check publisher's open access policy
ISSN 0749-5161
Publication date 2008
Sub-type Article (original research)
DOI 10.1097/PEC.0b013e318180fdb5
Volume 24
Issue 8
Start page 529
End page 533
Total pages 5
Language eng
Subject 2735 Pediatrics, Perinatology, and Child Health
2711 Emergency Medicine
Abstract Objective: To describe intravenous ketamine dosing regimens for children requiring brief procedural sedation. Methods: Time-concentration and sedation profiles were simulated in children (2, 6, and 12 years old) using published pediatric pharmacokinetic and pharmacodynamic parameter estimates. Single-dose, repeat-dosing, and infusion regimens to achieve sedation level of less than 2 (arouses slowly to consciousness, with sustained painful stimulus) for 15 minutes were investigated. Results: A single bolus dose of 1.5 and 1.75, 2, and 2.125 mg/kg (for adult and 12-, 6-, and 2-year-olds, respectively) was required to achieve the desired sedation. Anticipated recovery would be slow, and a sedation level of 4 (drowsy, eyes open or closed but easily arouses to consciousness with verbal stimulus) was reached only after 70 minutes. The use of a smaller initial bolus with a subsequent half-dose "top-up" at 8 minutes achieves the same sedation level but with earlier recovery. A smaller initial dose of 0.25 and 0.275, 0.3, and 0.35 mg/kg followed by an infusion 2.5 and 2.75, 3, and 3.5 mg/kg per hour (for adult and 12-, 6-, and 2-year-olds, respectively) for 15 minutes gives a more even sedation level and rapid recovery (20 minutes to sedation level 4). Conclusions: Dosing increases with decreasing age. A large single dose is associated with deep sedation, possible adverse effects, and delayed recovery. Between-subjects variability is large, and dose should be tailored to clinical monitoring and requirement. Intermittent pain insult is better suited to a top-up technique, whereas continuous pain is better suited to an infusion technique. Copyright
Keyword Allometrics
Procedural sedation
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: Scopus Import
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Citation counts: TR Web of Science Citation Count  Cited 11 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 16 times in Scopus Article | Citations
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Created: Tue, 03 Feb 2015, 11:33:23 EST by Ms Kate Rowe