Original Article
Access this article online Website: www.ijciis.org DOI: 10.4103/2229-5151.141352 Quick Response Code:
Comparison of the effect of intravenous ketamine and intramuscular ketamine for orthopedic procedures in children’s sedation Mehdi Momeni, Mohsen Esfandbod, Morteza Saeedi, Mohamadreza Farnia, Roya Basirani, Jeyran Zebardast
ABSTRACT Background: Ketamine is used as a general anesthetic for short‑term surgical procedures. The aim of this study is to compare the effect of intravenous (IV) ketamine and intramuscular (IM) ketamine in children admitted to the emergency department (ED). Materials and Methods: This is a clinical trial on 60 patients who were randomly classified into two groups. The first group received IV ketamine (1 mg/kg) and the second received IM ketamine (4 mg/kg). Data were collected before, during, and after the procedure. Time to reach sedation, severity of the sedation, and complications of the drug until discharge were studied.
Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Address for correspondence: Dr. Morteza Saeedi, Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. E‑mail: [email protected]
Results: In this study, 60 patients were evaluated. The average length of the procedures was similar in both groups (P > 0.05). According to this study, sedation levels in the two groups in 5, 10, and 15 minutes did not show significant differences (P > 0.05), but there was a significant difference in sedation levels of patients in 30, 35, 40, and 45 minutes during sedation (P = 0.03, P = 0.04, P = 0.03 and P = 0.05). There was no significant difference in the incidence of complications between the two groups. Dicussion: There was no significant difference in complications and level of sedation in both groups, but sedation was longer in the IM group; so, IV ketamine is the desirable approach for orthopedic procedures in sedating children. Key Words: Children sedation, intramuscular ketamine, intravenous ketamine, orthopedic
procedures
INTRODUCTION Painful diagnostic and therapeutic procedures performed in the emergency department (ED) for children is a routine action. Today, the number of therapeutic and diagnostic techniques that are used in the ED has increased;[1‑7] so, the use of sedation for painful procedures in emergency care for children with a standard diet and various medical regimens has special benefits.[8‑12] However, different drugs that are used for children have various dangerous side effects. [13,14] There are several ways to achieve adequate sedation. [9,10,14,15] One of the most important effective sedative methods is using ketamine as an anesthetic drug.[11,12,16] Ketamine is now commonly used
in the pediatric ED for sedation and can be administrated intramuscularly (IM) and/or intravenously (IV). [10,11] Comparison of IV with IM ketamine may assist in selecting the most effective and safest procedure for medical care in the ED. The aim of this study is to compare effects of IV ketamine with IM ketamine in children who were admitted to the ED and were in need of sedation for therapeutic procedures.
MATERIALS AND METHODS This is a single‑blind, clinical trial on 60 pediatric patients who were referred to the ED during 2010. All patients were enrolled after informed consent was obtained from their
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
191
Momeni, et al.: Ketamine in pediatric sedation
parents. There was no added cost for the patients due to this study. All the patients were alert, hemodynamically stable, and less than five years old. They were randomized by an allocation software to two groups that received IV ketamine (1 mg/kg) and IM ketamine (4 mg/kg). Information about the patients during and after the procedure, time to reach sedation, severity of sedation, and complications of the drug until discharge were obtained. All drugs had been prepared in 5 mL syringes in the ED and also contained 0.02 mg/kg atropin and 0.05 mg/kg midazolam. All injections were administered under the supervision of the Professor of Emergency Medicine. Exclusion criteria were: (1) Age less than 12 months, (2) age over 5 years, (3) history of known allergy to the drugs, (4) patients with open globe injury, (5) patients with traumatic brain injury, (6) patients with a history of psychiatric disorders, and (7) patients with memory impairment or cognitive impairment. The Ramsay sedation scale was used to assess the level of sedation. Ramsay sedation scale: 1. Patient is co‑operative, oriented, and tranquil 2. Patient is anxious and agitated or restless, or both 3. Patient responds to commands only 4. Patient exhibits brisk response to light glabellar tap or loud auditory stimulus 5. Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus 6. Patient exhibits no response. Recovery time was calculated from the last dose of drug adminstrated up to the time patients achieved discharge criteria. Patients with scores equal to or more than 7 were considered safe for discharge [Table 1]. Sedation levels and side effects based on data collection forms at 5, 10, 15, 20, 30, 45, 50, 55, and 60 minutes after injection were measured. After collecting data, SPSS software version 15 descriptive and inferential analysis was used for analysis; P 0.05). Sedation levels in the two groups at 5, 10, and 15 minutes did not show significant differences (P > 0.05), but the study at 30, 35, 40, and 45 minutes showed a significant difference in sedation levels (P = 0.03, P = 0.04, P = 0.03, and P = 0.05). All the patients were awake after 50 minutes in both groups [Tables 2 and 3]. There were no significant differences between the two groups in the incidence of vomiting (P > 0.05) [Table 4]. Also, there was no significant difference between the two groups in the incidence of other disorders or complications related to the adminstaration of IV and IM ketamine. The mean of duration of sedation differed significantly between the two groups (P = 0.05) and children in the IM ketamine group experienced longer sedation than the other group.
DISCUSSION In this study, 60 children were studied to compare the effects of IV and IM ketamine in pediatric sedation for Table 1: Discharge criteria consistings of for parts Activity
Breathing Circulation Level of consciousness
Can-not move without help Moves head or limbs spontaneously or with command Capable of lifting or moving the head and limbs, spontaneously Apnea Dyspnea and irregular breathing Being able to breathe deeply and cough to command Arterial blood pressure below 80 mmHg Arterial blood pressure between 80 and 100 mmHg Norman blood pressure for patients Failure to respond or responds only to painful stimuli Responds to verbal stimulation but simply goes to sleep Awake and alert to time, place, and person
Table 2: Sedation time and sedation level scores in patients who received 4 mg/kg intramuscular ketamine Sedation time (minutes) (Sedation level score)
1 2 3 4 5 6
5 n (%)
10-40 n (%)
45 n (%)
50-60 n (%)
0 (0) 0 (0) 0 (0) 0 (0) 4 (3.3) 26 (86.7)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
0 (0) 0 (0) 0 (0) 3 (10.4) 6 (20) 20 (66.6)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
Momeni, et al.: Ketamine in pediatric sedation
Table 3: Sedation time and sedation level scores in patients who received 1 mg/kg intravenous ketamine Sedation time (minutes) (Sedation level score)
1 2 3 4 5 6
5n (%)
10 n (%)
15 n (%)
20 n (%)
25 n (%)
30 n (%)
35 n (%)
40-60 n (%)
0 (0) 0 (0) 0 (0) 0 (0) 3 (10) 27 (90)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
0 (0) 0 (0) 0 (0) 0 (0) 2 (6.6) 28 (93.4)
0 (0) 0 (0) 0 (0) 0 (0) 5 (16.4) 25 (83.6)
2 (6.6) 1 (3.3) 3 (10) 5 (16.6) 9 (30) 10 (33.3)
23 (76.6) 7 (23.4) 0 (0) 0 (0) 0 (0) 0 (0)
30 (100) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
Table 4: Complications of treatment Nausea and vomiting
No Yes
Ketamine group 4 mg/kg, ketamine; Intramuscular
Total
1 mg/kg, ketamine; Intravenous
n
%
n
%
n
%
27 3
45 5
29 1
48.3 1.7
56 4
93.3 6.7
orthopedic procedures. Shorter duration of sedation in patients who received IV ketamine was the most important finding that led to earlier return of consciousness and discharge of the patiens. This finding may lower the anxiety of parents. According to a study by Joe E. Wathen et al. about the usage of IV ketamine for pediatric sedation (1 mg/kg IV) in the emergency department, it was seen that the incidence of pulmonary complications was 4.5%, vomiting 18.7%, and 7.1% incidence of hallucinations and delusions in patients who received ketamine. In another study in 2006 by Roback MG, et al., the effects of IM and IV sedation using ketamine in children admitted to the ED with orthopedic trauma were compared. The results show that the incidence of nausea was higher (11.9%) in the group who received IM ketamine.[4] Our study showed the incidence of vomiting (5 vs. 1.7%) in the ketamine IM group and ketamine IV group. The incidence of vomiting was higher in the patients who received IM ketamine. Roback MG et al. in a study reported that the duration of sedation by IM ketamine was more than in the IV route; this is similar to our results (36.2 ± 0.5 minutes in the IV group vs. 56.5 ± 0.6 minutes in IM ketamine group). All the children were awake and conscious during the first hour after adminstration of the drug. Other side effects during evaluation were not observed. Considering better control of the sedation of patients and lack of side effects, ketamine is more effective and safer in both IV and IM adminstration. IV administration of ketamine, due to faster results and quicker healing and awakening (shorter‑term sedation), can have a relatively better prognosis.
It requires minimum serious intervention and is recommended for pediatric sedation, but exact control of the duration of sedation and careful examination of the side effects in patients is necessary and should be scrutinizingly evaluated. No significant difference was seen in vomiting complications between the two groups. On the other hand, the recovery time did not differ neither did the risk of aspiration.
CONCLUSION There was no significant difference in complications between the two groups, but a longer duration of sedation was observed in the IM ketamine group which makes IV ketamine more desirable. We recommend that in future studies, the clinical status of patients and its alteration be evaluated precisely to determine the most efficient method of pediatric sedation.
REFERENCES 1.
Chudnofsky CR, Lozon MM. Procedural Sedation and Analgesia. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen's emergency medicine: Concepts and clinical practice. 6th ed. Philadelphia, PA: Mosby; 2006. p. 2938‑55. 2. Shah RK, Singh RP, Prasad N. Sedation with ketamine: A Safe and effective anaesthetic agent for children in the developing world. Nepal Med Coll J 2003;5:9‑13. 3. Karapinar B, Yilmaz D, Demirağ K, Kantar M. Sedation with ketamine and midazolam for painful procedures in children. Pediatr Int 2006;48:146‑51. 4. Roback MG. Wathen JE, Mackenzie T, Bajaj L. A Randomized, Controlled trial of IV versos IM Ketamine for Sedation of pediatric receiving emergency department Orthopedic procedures. Ann Emerg Med 2006;48:605‑12. 5. Green SM, Johnson NE. Ketamine sedation for pediatric procedures: Part 2, Review and implications. Ann Emerg Med 1990;19:1033‑46. 6. Green SM, Hummel CB, Wittlake WA, Rothrock SG, Hopkins GA, Garrett W. What is the optimal dose of intramuscular ketamine for pediatric sedation. Acad Emerg Med 1999;6:21‑6. 7. Walls R, Murphy MF. Manual of emergency airway management. Philadelphia, PA: Lippincott Williams and Wilkins; 2004. 8. Qureshi FA, Mellis PT, McFadden MA. Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair. Pediatr Emerg Care 1995;11:93‑7. 9. Horiuchi T, Kawaguchi M, Kurehara K, Kawaraguchi Y, Sasaoka N, Furuya H. Evaluation of relatively low dose oforal transmucosal ketamine premedication in children: A comparison with oral midazolam. Paediatr Anaesth 2005;15:643‑7. 10. Miller R, Fleisher L, Roger A. General anesthesia. Miller’s Anesthesia. 6th ed, Vol. 1. New York: Churchill livingstone; 2005. p. 379‑410. 11. White PF, Way WL, Trevor AJ. Ketamine: Its pharmacology and therapeutic uses. Anesthesiology 1982;56:119‑36.
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
193
Momeni, et al.: Ketamine in pediatric sedation 12. Hall J, Collyer T. Ketamine sedation in children. Emerg Nurse 2007;15:24‑7. 13. Cravero JP, Blike GT. Review of pediatric sedation. Anesth Analg 2004;99:1355‑64. 14. Melzack R, McGill T. Major properties and scoring methods of pain. Pain 1995;1:277‑99. 15. Finkel JC, Pestieau SR, Quezado ZM. Ketamine as an adjuvant for treatment of cancer pain in children and adolescents. Pain 2007;8:515‑21 16. Neil S. Morton MBChB, FRCA, FRCPCH Ketamine for procedural
sedation and analgesia in pediatric emergency medicine: A UK perspective Pediatric Anesthesia 2007;18 ;1:25-9. Cite this article as: Momeni M, Esfandbod M, Saeedi M, Farnia M, Basirani R, Zebardast J. Comparison of the effect of intravenous ketamine and intramuscular ketamine for orthopedic procedures in children's sedation. Int J Crit Illn Inj Sci 2014;4:191-4. Source of Support: Nil, Conflict of Interest: No.
Author Help: Online submission of the manuscripts Articles can be submitted online from http://www.journalonweb.com. For online submission, the articles should be prepared in two files (first page file and article file). Images should be submitted separately. 1) First Page File: Prepare the title page, covering letter, acknowledgement etc. using a word processor program. All information related to your identity should be included here. Use text/rtf/doc/pdf files. Do not zip the files. 2) Article File: The main text of the article, beginning with the Abstract to References (including tables) should be in this file. Do not include any information (such as acknowledgement, your names in page headers etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size to 1024 kb. Do not incorporate images in the file. If file size is large, graphs can be submitted separately as images, without their being incorporated in the article file. This will reduce the size of the file. 3) Images: Submit good quality color images. Each image should be less than 4096 kb (4 MB) in size. The size of the image can be reduced by decreasing the actual height and width of the images (keep up to about 6 inches and up to about 1800 x 1200 pixels). JPEG is the most suitable file format. The image quality should be good enough to judge the scientific value of the image. For the purpose of printing, always retain a good quality, high resolution image. This high resolution image should be sent to the editorial office at the time of sending a revised article. 4) Legends: Legends for the figures/images should be included at the end of the article file.
194
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
Copyright of International Journal of Critical Illness & Injury Science is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Access this article online Website: www.ijciis.org DOI: 10.4103/2229-5151.141352 Quick Response Code:
Comparison of the effect of intravenous ketamine and intramuscular ketamine for orthopedic procedures in children’s sedation Mehdi Momeni, Mohsen Esfandbod, Morteza Saeedi, Mohamadreza Farnia, Roya Basirani, Jeyran Zebardast
ABSTRACT Background: Ketamine is used as a general anesthetic for short‑term surgical procedures. The aim of this study is to compare the effect of intravenous (IV) ketamine and intramuscular (IM) ketamine in children admitted to the emergency department (ED). Materials and Methods: This is a clinical trial on 60 patients who were randomly classified into two groups. The first group received IV ketamine (1 mg/kg) and the second received IM ketamine (4 mg/kg). Data were collected before, during, and after the procedure. Time to reach sedation, severity of the sedation, and complications of the drug until discharge were studied.
Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Address for correspondence: Dr. Morteza Saeedi, Department of Emergency Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. E‑mail: [email protected]
Results: In this study, 60 patients were evaluated. The average length of the procedures was similar in both groups (P > 0.05). According to this study, sedation levels in the two groups in 5, 10, and 15 minutes did not show significant differences (P > 0.05), but there was a significant difference in sedation levels of patients in 30, 35, 40, and 45 minutes during sedation (P = 0.03, P = 0.04, P = 0.03 and P = 0.05). There was no significant difference in the incidence of complications between the two groups. Dicussion: There was no significant difference in complications and level of sedation in both groups, but sedation was longer in the IM group; so, IV ketamine is the desirable approach for orthopedic procedures in sedating children. Key Words: Children sedation, intramuscular ketamine, intravenous ketamine, orthopedic
procedures
INTRODUCTION Painful diagnostic and therapeutic procedures performed in the emergency department (ED) for children is a routine action. Today, the number of therapeutic and diagnostic techniques that are used in the ED has increased;[1‑7] so, the use of sedation for painful procedures in emergency care for children with a standard diet and various medical regimens has special benefits.[8‑12] However, different drugs that are used for children have various dangerous side effects. [13,14] There are several ways to achieve adequate sedation. [9,10,14,15] One of the most important effective sedative methods is using ketamine as an anesthetic drug.[11,12,16] Ketamine is now commonly used
in the pediatric ED for sedation and can be administrated intramuscularly (IM) and/or intravenously (IV). [10,11] Comparison of IV with IM ketamine may assist in selecting the most effective and safest procedure for medical care in the ED. The aim of this study is to compare effects of IV ketamine with IM ketamine in children who were admitted to the ED and were in need of sedation for therapeutic procedures.
MATERIALS AND METHODS This is a single‑blind, clinical trial on 60 pediatric patients who were referred to the ED during 2010. All patients were enrolled after informed consent was obtained from their
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
191
Momeni, et al.: Ketamine in pediatric sedation
parents. There was no added cost for the patients due to this study. All the patients were alert, hemodynamically stable, and less than five years old. They were randomized by an allocation software to two groups that received IV ketamine (1 mg/kg) and IM ketamine (4 mg/kg). Information about the patients during and after the procedure, time to reach sedation, severity of sedation, and complications of the drug until discharge were obtained. All drugs had been prepared in 5 mL syringes in the ED and also contained 0.02 mg/kg atropin and 0.05 mg/kg midazolam. All injections were administered under the supervision of the Professor of Emergency Medicine. Exclusion criteria were: (1) Age less than 12 months, (2) age over 5 years, (3) history of known allergy to the drugs, (4) patients with open globe injury, (5) patients with traumatic brain injury, (6) patients with a history of psychiatric disorders, and (7) patients with memory impairment or cognitive impairment. The Ramsay sedation scale was used to assess the level of sedation. Ramsay sedation scale: 1. Patient is co‑operative, oriented, and tranquil 2. Patient is anxious and agitated or restless, or both 3. Patient responds to commands only 4. Patient exhibits brisk response to light glabellar tap or loud auditory stimulus 5. Patient exhibits a sluggish response to light glabellar tap or loud auditory stimulus 6. Patient exhibits no response. Recovery time was calculated from the last dose of drug adminstrated up to the time patients achieved discharge criteria. Patients with scores equal to or more than 7 were considered safe for discharge [Table 1]. Sedation levels and side effects based on data collection forms at 5, 10, 15, 20, 30, 45, 50, 55, and 60 minutes after injection were measured. After collecting data, SPSS software version 15 descriptive and inferential analysis was used for analysis; P 0.05). Sedation levels in the two groups at 5, 10, and 15 minutes did not show significant differences (P > 0.05), but the study at 30, 35, 40, and 45 minutes showed a significant difference in sedation levels (P = 0.03, P = 0.04, P = 0.03, and P = 0.05). All the patients were awake after 50 minutes in both groups [Tables 2 and 3]. There were no significant differences between the two groups in the incidence of vomiting (P > 0.05) [Table 4]. Also, there was no significant difference between the two groups in the incidence of other disorders or complications related to the adminstaration of IV and IM ketamine. The mean of duration of sedation differed significantly between the two groups (P = 0.05) and children in the IM ketamine group experienced longer sedation than the other group.
DISCUSSION In this study, 60 children were studied to compare the effects of IV and IM ketamine in pediatric sedation for Table 1: Discharge criteria consistings of for parts Activity
Breathing Circulation Level of consciousness
Can-not move without help Moves head or limbs spontaneously or with command Capable of lifting or moving the head and limbs, spontaneously Apnea Dyspnea and irregular breathing Being able to breathe deeply and cough to command Arterial blood pressure below 80 mmHg Arterial blood pressure between 80 and 100 mmHg Norman blood pressure for patients Failure to respond or responds only to painful stimuli Responds to verbal stimulation but simply goes to sleep Awake and alert to time, place, and person
Table 2: Sedation time and sedation level scores in patients who received 4 mg/kg intramuscular ketamine Sedation time (minutes) (Sedation level score)
1 2 3 4 5 6
5 n (%)
10-40 n (%)
45 n (%)
50-60 n (%)
0 (0) 0 (0) 0 (0) 0 (0) 4 (3.3) 26 (86.7)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
0 (0) 0 (0) 0 (0) 3 (10.4) 6 (20) 20 (66.6)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
Momeni, et al.: Ketamine in pediatric sedation
Table 3: Sedation time and sedation level scores in patients who received 1 mg/kg intravenous ketamine Sedation time (minutes) (Sedation level score)
1 2 3 4 5 6
5n (%)
10 n (%)
15 n (%)
20 n (%)
25 n (%)
30 n (%)
35 n (%)
40-60 n (%)
0 (0) 0 (0) 0 (0) 0 (0) 3 (10) 27 (90)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 30 (100)
0 (0) 0 (0) 0 (0) 0 (0) 2 (6.6) 28 (93.4)
0 (0) 0 (0) 0 (0) 0 (0) 5 (16.4) 25 (83.6)
2 (6.6) 1 (3.3) 3 (10) 5 (16.6) 9 (30) 10 (33.3)
23 (76.6) 7 (23.4) 0 (0) 0 (0) 0 (0) 0 (0)
30 (100) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
Table 4: Complications of treatment Nausea and vomiting
No Yes
Ketamine group 4 mg/kg, ketamine; Intramuscular
Total
1 mg/kg, ketamine; Intravenous
n
%
n
%
n
%
27 3
45 5
29 1
48.3 1.7
56 4
93.3 6.7
orthopedic procedures. Shorter duration of sedation in patients who received IV ketamine was the most important finding that led to earlier return of consciousness and discharge of the patiens. This finding may lower the anxiety of parents. According to a study by Joe E. Wathen et al. about the usage of IV ketamine for pediatric sedation (1 mg/kg IV) in the emergency department, it was seen that the incidence of pulmonary complications was 4.5%, vomiting 18.7%, and 7.1% incidence of hallucinations and delusions in patients who received ketamine. In another study in 2006 by Roback MG, et al., the effects of IM and IV sedation using ketamine in children admitted to the ED with orthopedic trauma were compared. The results show that the incidence of nausea was higher (11.9%) in the group who received IM ketamine.[4] Our study showed the incidence of vomiting (5 vs. 1.7%) in the ketamine IM group and ketamine IV group. The incidence of vomiting was higher in the patients who received IM ketamine. Roback MG et al. in a study reported that the duration of sedation by IM ketamine was more than in the IV route; this is similar to our results (36.2 ± 0.5 minutes in the IV group vs. 56.5 ± 0.6 minutes in IM ketamine group). All the children were awake and conscious during the first hour after adminstration of the drug. Other side effects during evaluation were not observed. Considering better control of the sedation of patients and lack of side effects, ketamine is more effective and safer in both IV and IM adminstration. IV administration of ketamine, due to faster results and quicker healing and awakening (shorter‑term sedation), can have a relatively better prognosis.
It requires minimum serious intervention and is recommended for pediatric sedation, but exact control of the duration of sedation and careful examination of the side effects in patients is necessary and should be scrutinizingly evaluated. No significant difference was seen in vomiting complications between the two groups. On the other hand, the recovery time did not differ neither did the risk of aspiration.
CONCLUSION There was no significant difference in complications between the two groups, but a longer duration of sedation was observed in the IM ketamine group which makes IV ketamine more desirable. We recommend that in future studies, the clinical status of patients and its alteration be evaluated precisely to determine the most efficient method of pediatric sedation.
REFERENCES 1.
Chudnofsky CR, Lozon MM. Procedural Sedation and Analgesia. In: Marx JA, Hockberger RS, Walls RM, editors. Rosen's emergency medicine: Concepts and clinical practice. 6th ed. Philadelphia, PA: Mosby; 2006. p. 2938‑55. 2. Shah RK, Singh RP, Prasad N. Sedation with ketamine: A Safe and effective anaesthetic agent for children in the developing world. Nepal Med Coll J 2003;5:9‑13. 3. Karapinar B, Yilmaz D, Demirağ K, Kantar M. Sedation with ketamine and midazolam for painful procedures in children. Pediatr Int 2006;48:146‑51. 4. Roback MG. Wathen JE, Mackenzie T, Bajaj L. A Randomized, Controlled trial of IV versos IM Ketamine for Sedation of pediatric receiving emergency department Orthopedic procedures. Ann Emerg Med 2006;48:605‑12. 5. Green SM, Johnson NE. Ketamine sedation for pediatric procedures: Part 2, Review and implications. Ann Emerg Med 1990;19:1033‑46. 6. Green SM, Hummel CB, Wittlake WA, Rothrock SG, Hopkins GA, Garrett W. What is the optimal dose of intramuscular ketamine for pediatric sedation. Acad Emerg Med 1999;6:21‑6. 7. Walls R, Murphy MF. Manual of emergency airway management. Philadelphia, PA: Lippincott Williams and Wilkins; 2004. 8. Qureshi FA, Mellis PT, McFadden MA. Efficacy of oral ketamine for providing sedation and analgesia to children requiring laceration repair. Pediatr Emerg Care 1995;11:93‑7. 9. Horiuchi T, Kawaguchi M, Kurehara K, Kawaraguchi Y, Sasaoka N, Furuya H. Evaluation of relatively low dose oforal transmucosal ketamine premedication in children: A comparison with oral midazolam. Paediatr Anaesth 2005;15:643‑7. 10. Miller R, Fleisher L, Roger A. General anesthesia. Miller’s Anesthesia. 6th ed, Vol. 1. New York: Churchill livingstone; 2005. p. 379‑410. 11. White PF, Way WL, Trevor AJ. Ketamine: Its pharmacology and therapeutic uses. Anesthesiology 1982;56:119‑36.
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
193
Momeni, et al.: Ketamine in pediatric sedation 12. Hall J, Collyer T. Ketamine sedation in children. Emerg Nurse 2007;15:24‑7. 13. Cravero JP, Blike GT. Review of pediatric sedation. Anesth Analg 2004;99:1355‑64. 14. Melzack R, McGill T. Major properties and scoring methods of pain. Pain 1995;1:277‑99. 15. Finkel JC, Pestieau SR, Quezado ZM. Ketamine as an adjuvant for treatment of cancer pain in children and adolescents. Pain 2007;8:515‑21 16. Neil S. Morton MBChB, FRCA, FRCPCH Ketamine for procedural
sedation and analgesia in pediatric emergency medicine: A UK perspective Pediatric Anesthesia 2007;18 ;1:25-9. Cite this article as: Momeni M, Esfandbod M, Saeedi M, Farnia M, Basirani R, Zebardast J. Comparison of the effect of intravenous ketamine and intramuscular ketamine for orthopedic procedures in children's sedation. Int J Crit Illn Inj Sci 2014;4:191-4. Source of Support: Nil, Conflict of Interest: No.
Author Help: Online submission of the manuscripts Articles can be submitted online from http://www.journalonweb.com. For online submission, the articles should be prepared in two files (first page file and article file). Images should be submitted separately. 1) First Page File: Prepare the title page, covering letter, acknowledgement etc. using a word processor program. All information related to your identity should be included here. Use text/rtf/doc/pdf files. Do not zip the files. 2) Article File: The main text of the article, beginning with the Abstract to References (including tables) should be in this file. Do not include any information (such as acknowledgement, your names in page headers etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size to 1024 kb. Do not incorporate images in the file. If file size is large, graphs can be submitted separately as images, without their being incorporated in the article file. This will reduce the size of the file. 3) Images: Submit good quality color images. Each image should be less than 4096 kb (4 MB) in size. The size of the image can be reduced by decreasing the actual height and width of the images (keep up to about 6 inches and up to about 1800 x 1200 pixels). JPEG is the most suitable file format. The image quality should be good enough to judge the scientific value of the image. For the purpose of printing, always retain a good quality, high resolution image. This high resolution image should be sent to the editorial office at the time of sending a revised article. 4) Legends: Legends for the figures/images should be included at the end of the article file.
194
International Journal of Critical Illness and Injury Science | Vol. 4 | Issue 3 | Jul-Sep 2014
Copyright of International Journal of Critical Illness & Injury Science is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
