Ketamine sedation
children
RCEM 2020 Best Practice Guideline: Procedural Sedation for Children (https://rcem.ac.uk/wp-content/uploads/2022/02/Ketamine_Procedural_Sedation_-for_Children_in_EDs_Feb_2020.pdf)
patient selection
- Right patient?
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24 months (as per college guidelines)
- beware hypersalivation/secretions
- patients are typically unfasted → are you prepared to take over airway if needed? Can the procedure be deferred?
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- Right procedure?
- is this short enough?
- Right place?
- Is ED/resus the right place, not theatre?
- Is the department safe enough to allow you the extra time to do it here?
contraindications as per RCEM
Procedure unsuitable:
- Proposed procedure within the mouth or pharynx
- Age less than 12 months
- Prior adverse reaction to ketamine (....duh)
Airway/breathing:
- Active respiratory infection, active asthma
- Unstable or abnormal airway
- Tracheal surgery or stenosis
- Active upper or lower respiratory tract infection
Circulation:
- Significant cardiac disease
Disability:
- Patients with severe psychological problems such as cognitive or motor delay or severe behavioural problems
- Recent significant head injury or reduced level of consciousness
- Intracranial hypertension with CSF obstruction
- Previous psychotic illness
- Uncontrolled epilepsy
Exposure:
- Hyperthyroidism or thyroid medication
- Porphyria
- Intra-ocular pathology
before procedure
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Analgesia before sedation - best multimodal stuff, not just IN fentanyl!
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IM?
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IV: 1mg/kg over at least 60 seconds
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Recovery over 60-120 mins