Intravenous ketamine sedation for painful oncology procedures
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...
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| Published in | Pediatric anesthesia Vol. 15; no. 2; pp. 131 - 138 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Publishing Ltd
01.02.2005
Blackwell |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1155-5645 1460-9592 |
| DOI | 10.1111/j.1460-9592.2005.01407.x |
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| Abstract | 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. |
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| AbstractList | 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.
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.
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%.
Ketamine i.v. up to 2 mg.kg(-1) is an effective sedative for oncology procedures using a defined protocol. 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.BACKGROUNDThe 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.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.METHODSA 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.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%.RESULTSFifty-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%.Ketamine i.v. up to 2 mg.kg(-1) is an effective sedative for oncology procedures using a defined protocol.CONCLUSIONKetamine i.v. up to 2 mg.kg(-1) is an effective sedative for oncology procedures using a defined protocol. 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. 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 (SpO 2 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. |
| Author | EVANS, DAN ROGERS, PAUL TURNHAM, LUCY WILSON, LAURA J. MONTGOMERY, CAROLYNE KOBE, JEFF VANDEBEEK, CHRISTINE BARBOUR, KATHRYN |
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| Keywords | lumbar puncture Intravenous administration bone marrow biopsy procedural sedation Glutamate receptor Sedation Pain Ketamine General anesthetic Biopsy Bone marrow Anesthesia Antagonist NMDA receptor |
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| References_xml | – reference: Tobias JD. End-tidal carbon dioxide monitoring during sedation with a combination of midazolam and ketamine for children undergoing painful, invasive procedures. Pediatr Emerg Care 1999; 15: 173-175. – reference: Kennedy RM, Porter FL, Miller JP et al. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics 1998; 102(Pt 1):956-963. – reference: Green SM, Krauss B. The semantics of ketamine. Ann Emerg Med 2000; 36: 480-482. – reference: Cote CJ. The semantics of ketamine. Ann Emerg Med 2001; 38: 92-95. – reference: Hart LS, Berns SD, Houck CS et al. The value of end-tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department. Pediatr Emerg Care 1997; 13: 189-193. – reference: Gloor A, Dillier C, Gerber A. Ketamine for short ambulatory procedures in children: an audit. Paediatr Anaesth 2001; 11: 533-539. – reference: Meyer S, Aliani S, Graf N et al. Sedation with midazolam and ketamine for invasive procedures in children with malignancies and hematological disorders: a prospective study with reference to the sympathomimetic properties of ketamine. Pediatr Hematol Oncol 2003; 20: 291-301. – reference: American Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: addendum. Pediatrics 2002; 110: 836-838. – reference: Sherwin TS, Green SM, Khan A et al. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial. Ann Emerg Med 2000; 35: 229-238. – reference: Rockoff M, Cote C, Kaplan R. Sedation for procedures. Pediatrics 1997; 100: 1045-1046. – reference: Parker RI, Mahan RA, Giugliano D et al. Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children. Pediatrics 1997; 99: 427-431. – reference: Mason KP, Michna E, DiNardo JA et al. Evolution of a protocol for ketamine-induced sedation as an alternative to general anesthesia for interventional radiologic procedures in pediatric patients. Radiology 2002; 225: 457-465. – reference: Hoffman GM, Nowakowski R, Troshynski TJ et al. Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics 2002; 109: 236-243. – reference: Green SM, Rothrock SG, Harris T et al. Intravenous ketamine for pediatric sedation in the emergency department: safety profile with 156 cases. Acad Emerg Med 1998; 5: 971-976. – reference: Wathen JE, Roback MG, Mackenzie T et al. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial. Ann Emerg Med 2000; 36: 579-588. – reference: Kim G, Green SM, Denmark TK et al. Ventilatory response during dissociative sedation in children - a pilot study. Acad Emerg Med 2003; 10: 140-145. – reference: Dachs RJ, Innes GM. Intravenous ketamine sedation of pediatric patients in the emergency department. Ann Emerg Med 1997; 29: 146-150. – reference: American Society of Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004-1017. – reference: Pellier I, Monrigal JP, Le Moine P et al. Use of intravenous ketamine-midazolam association for pain procedures in children with cancer. A prospective study. Paediatr Anaesth 1999; 9: 61-68. – reference: Sakai T, Baba S, Ishihara H et al. Sudden diabetes insipidus induced by ketamine infusion. Agressologie 1986; 27: 499-500. – volume: 5 start-page: 971 year: 1998 end-page: 976 article-title: Intravenous ketamine for pediatric sedation in the emergency department: safety profile with 156 cases publication-title: Acad Emerg Med – volume: 110 start-page: 836 year: 2002 end-page: 838 article-title: Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: addendum publication-title: Pediatrics – volume: 11 start-page: 533 year: 2001 end-page: 539 article-title: Ketamine for short ambulatory procedures in children: an audit publication-title: Paediatr Anaesth – volume: 36 start-page: 579 year: 2000 end-page: 588 article-title: Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double‐blind, randomized, controlled, emergency department trial publication-title: Ann Emerg Med – volume: 225 start-page: 457 year: 2002 end-page: 465 article-title: Evolution of a protocol for ketamine‐induced sedation as an alternative to general anesthesia for interventional radiologic procedures in pediatric patients publication-title: Radiology – volume: 38 start-page: 92 year: 2001 end-page: 95 article-title: The semantics of ketamine publication-title: Ann Emerg Med – volume: 15 start-page: 173 year: 1999 end-page: 175 article-title: End‐tidal carbon dioxide monitoring during sedation with a combination of midazolam and ketamine for children undergoing painful, invasive procedures publication-title: Pediatr Emerg Care – volume: 35 start-page: 229 year: 2000 end-page: 238 article-title: Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double‐blind, placebo‐controlled trial publication-title: Ann Emerg Med – volume: 20 start-page: 291 year: 2003 end-page: 301 article-title: Sedation with midazolam and ketamine for invasive procedures in children with malignancies and hematological disorders: a prospective study with reference to the sympathomimetic properties of ketamine publication-title: Pediatr Hematol Oncol – volume: 13 start-page: 189 year: 1997 end-page: 193 article-title: The value of end‐tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department publication-title: Pediatr Emerg Care – volume: 29 start-page: 146 year: 1997 end-page: 150 article-title: Intravenous ketamine sedation of pediatric patients in the emergency department publication-title: Ann Emerg Med – volume: 102 start-page: 956 issue: Pt 1 year: 1998 end-page: 963 article-title: Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies publication-title: Pediatrics – volume: 99 start-page: 427 year: 1997 end-page: 431 article-title: Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children publication-title: Pediatrics – volume: 27 start-page: 499 year: 1986 end-page: 500 article-title: Sudden diabetes insipidus induced by ketamine infusion publication-title: Agressologie – volume: 96 start-page: 1004 year: 2002 end-page: 1017 article-title: Practice guidelines for sedation and analgesia by non‐anesthesiologists publication-title: Anesthesiology – volume: 100 start-page: 1045 year: 1997 end-page: 1046 article-title: Sedation for procedures publication-title: Pediatrics – volume: 109 start-page: 236 year: 2002 end-page: 243 article-title: Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model publication-title: Pediatrics – volume: 9 start-page: 61 year: 1999 end-page: 68 article-title: Use of intravenous ketamine‐midazolam association for pain procedures in children with cancer. A prospective study publication-title: Paediatr Anaesth – volume: 36 start-page: 480 year: 2000 end-page: 482 article-title: The semantics of ketamine publication-title: Ann Emerg Med – volume: 10 start-page: 140 year: 2003 end-page: 145 article-title: Ventilatory response during dissociative sedation in children – a pilot study publication-title: Acad Emerg Med – ident: e_1_2_14_15_2 doi: 10.1148/radiol.2252011786 – volume: 10 start-page: 140 year: 2003 ident: e_1_2_14_17_2 article-title: Ventilatory response during dissociative sedation in children – a pilot study publication-title: Acad Emerg Med doi: 10.1197/aemj.10.2.140 – ident: e_1_2_14_12_2 doi: 10.1542/peds.100.6.1045 – volume: 27 start-page: 499 year: 1986 ident: e_1_2_14_11_2 article-title: Sudden diabetes insipidus induced by ketamine infusion publication-title: Agressologie – ident: e_1_2_14_14_2 doi: 10.1016/S0196-0644(00)70073-4 – ident: e_1_2_14_21_2 doi: 10.1016/S0196-0644(97)70321-4 – ident: e_1_2_14_16_2 doi: 10.1542/peds.109.2.236 – ident: e_1_2_14_18_2 doi: 10.1097/00006565-199706000-00004 – ident: e_1_2_14_13_2 doi: 10.1067/mem.2000.111131 – ident: e_1_2_14_8_2 doi: 10.1067/mem.2001.115943 – ident: e_1_2_14_4_2 doi: 10.1542/peds.102.4.956 – ident: e_1_2_14_10_2 doi: 10.1097/00000542-200204000-00031 – ident: e_1_2_14_19_2 doi: 10.1097/00006565-199906000-00002 – ident: e_1_2_14_3_2 doi: 10.1542/peds.99.3.427 – ident: e_1_2_14_20_2 doi: 10.1080/713842312 – ident: e_1_2_14_2_2 doi: 10.1046/j.1460-9592.1999.9120280.x – ident: e_1_2_14_5_2 doi: 10.1111/j.1553-2712.1998.tb02773.x – ident: e_1_2_14_7_2 doi: 10.1016/S0196-0644(00)17343-3 – ident: e_1_2_14_6_2 doi: 10.1046/j.1460-9592.2001.00705.x – ident: e_1_2_14_9_2 doi: 10.1542/peds.110.4.836 |
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Background: The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by... Background: The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by nonanesthetist... The aim of the study was to determine the efficacy and adverse effects of intravenous (i.v.) ketamine sedation administered by nonanesthetist physicians for... |
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| SubjectTerms | 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 |
| Title | Intravenous ketamine sedation for painful oncology procedures |
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