Intravenous ketamine sedation for painful oncology procedures

• Published in: Pediatric anesthesia Vol. 15; no. 2; pp. 131 - 138
• Main Authors: EVANS, DAN, TURNHAM, LUCY, BARBOUR, KATHRYN, KOBE, JEFF, WILSON, LAURA, VANDEBEEK, CHRISTINE, J. MONTGOMERY, CAROLYNE, ROGERS, PAUL
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.02.2005; Blackwell
• Subjects: Adolescent; Analgesics - administration & dosage; Analgesics - adverse effects; Analgesics - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - therapeutic use; Biological and medical sciences; Biopsy, Needle - adverse effects; bone marrow biopsy; Bone Marrow Examination - adverse effects; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Humans; Infant; Injections, Intravenous - methods; ketamine; Ketamine - administration & dosage; Ketamine - adverse effects; Ketamine - therapeutic use; Lidocaine - therapeutic use; lumbar puncture; Male; Medical sciences; Pain - etiology; Pain - prevention & control; Pain Measurement - methods; Patient Satisfaction; Prilocaine - therapeutic use; procedural sedation; Spinal Puncture - adverse effects; Tetracaine - therapeutic use; Treatment Outcome; lumbar puncture; Intravenous administration; bone marrow biopsy; procedural sedation; Glutamate receptor; Sedation; Pain; Ketamine; General anesthetic; Biopsy; Bone marrow; Anesthesia; Antagonist; NMDA receptor
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1111/j.1460-9592.2005.01407.x

Summary Background:  The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by nonanesthetist physicians for painful procedures. Methods:  A single‐agent, procedural sedation protocol using titrated doses of ketamine i.v. (maximum 2 mg·kg−1) was conducted in outpatient pediatric oncology patients undergoing lumbar puncture (LP), bone marrow biopsy/aspiration (BMBx/A) or combination (LP/BMBx/A) in a tertiary care setting. The efficacy of analgesia and sedation (ability to perform the procedure), procedure duration, recovery time and the occurrence of adverse events are described. Results:  Fifty‐eight subjects of a median age of 5 years (1–13) and median weight of 20 kg (10.5–68) underwent 119 sedations. An LP was performed in 73% of cases, a BMBx/A in 13% and LP/BMBx/A in 13%. Efficacy was 100% and the mean dose of ketamine was 1.3 mg·kg−1 (0.4). The mean duration of the procedure was 6.6 min (4.2) and the recovery time was 11 min (4–45). Two subjects (1.7%) had a hypoxemia (SpO2 of <94%). No major airway complications occurred. The prevalence of hypertension (systolic > 20% at 5 min) was 54%. The median pain visual analogue score (VAS) for an observer was 0 (range 0–3) and caregiver was 0 (range 0–4). The median VAS for satisfaction (observer) was 10 (range 7–10) and caregiver VAS was also 10 (range 5–10). At 24 h after discharge, the incidence of bad dreams was 3.3%; vomiting, 10.8%; and abnormal behavior, 4.2%. Conclusion:  Ketamine i.v. up to 2 mg·kg−1 is an effective sedative for oncology procedures using a defined protocol.