Abstract ID: A25
Abstract Title: Nursing Administered Ketamine Protocol for Pediatric Interventional Radiology
Authors: Mason K1, Michna E2, Zurakowski D3, Forman R4
Children's Hospital Boston Boston MA USA1, Brigham and Women's Hospital Boston MA USA2, Children's Hospital Boston Boston MA USA3, Children's Hospital Boston Boston MA USA4
Poster Type: Poster
ABSTRACT BODY
Introduction
Painful pediatric procedures may be successfully accomplished with the use of intravenous (IV) ketamine for analgesia. This prospective study utilized a computerized sedation database to evaluate the efficacy and safety profile of a nursing-administered ketamine sedation.
Materials and Methods
In 2002 the Department of Anesthesia worked with the Department of Radiology to establish a ketamine protocol to provide intravenous analgesia for pediatric interventional radiological procedures. A computerized database documents patient demographics, medications, dosages administered and American Society of Anesthesiologists (ASA) physical status classification. Using this database we reviewed all infants and children who received intravenous (IV) ketamine between October 2001 and April 2005.
Results
There were a total of 321 sedations in 259 patients (128 males and 131 females). Children received a 2.0 mg/kg IV ketamine bolus followed by a ketamine infusion titrated between 50-125 mcg/kg/min. The infusion was titrated to the same endpoint on each child: minimal response to painful stimulation elicited by deep nailbed pressure or ear lobe pinch. Response to painful stimulation was recorded and elicited every 15 min. Mean age was 5.9 ± 3.6 yrs (4 mos-18 yrs). Mean weight was 21.3 ± 10.9 kg (3.3-82.8 kg). Distribution of ASA status: ASA 1 (4%), ASA 2 (54%), ASA 3 (38%), ASA 4 (4%). Procedures included peripheral central intravenous catheters (PICC, n=198, 62%), chest tubes (10%), G-tubes or nephrostomy tubes (7%), percutaneous biopsies (9%), sclerotherapy (3%), drainage (9%), and angiography (n=1). Mean sedation time was 52 ± 25 min, duration of procedure was 44 ± 24 min, and recovery time was 48 ± 40 min. Average infusion rate was 76 ± 50 mcg/kg/min. The failed sedation rate was 2.2% (7 patients). 2 patients had brief episodes of desaturation that responded immediately (<1 minute) to positive pressure ventilation. There were a total of 36 adverse events in the recovery room (11.2%): nausea (n=24), delirium (n=6), agitation (n=3) and need for supplemental oxygen (n=3). Multivariate analysis indicated that independent of gender, procedure or ASA status, patients less than 2 years of age had a higher risk of sedation failure, oxygen desaturation or need for resuscitation (P<0.05).
Conclusion
Ketamine is an effective sedative and analgesic for children undergoing painful interventional procedures in the setting of an organized, appropriately staffed and monitored sedation program.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A25