Adjunctive Atropine Versus Metoclopramide: Can We Reduce Ketamine‐associated Vomiting in Young Children? A Prospective, Randomized, Open, Controlled Study

Abstract

In this study, a high rate (28.4%) of KAV was observed, consistent with prior reports using the intramuscular (IM) route. However, the authors were unable to reduce KAV using adjunctive atropine or metoclopramide. Parents or caregivers should be given more detailed discharge instructions about vomiting and diet considering the relatively long time to resuming a normal diet after ketamine sedation and the fact that KAV often occurred after ED discharge.

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

“…Previous studies have reported that the rate of emesis following ketamine sedation in paediatric patients varied widely, ranging between 6% and 28%. (14)(15)(16)(17) However, some of these studies included any emesis that occurred up to 24 hours after discharge from hospital. In the present study, emesis was defined as having at least one episode of vomiting occurring before discharge from the ED.…”

“…(14) This was also the first study that aimed to identify the risk factors of emesis in children undergoing IM ketamine sedation in our diverse local population. Previous studies have reported that the rate of emesis following ketamine sedation in paediatric patients varied widely, ranging between 6% and 28%.…”

“…The rate of ketamine-associated emesis in paediatric patients has been reported to be in the range of 6%-28%, depending on the size of the study. (14)(15)(16)(17) Although a meta-analysis of 8,202 children showed that age and higher dosage of ketamine were associated with increased vomiting, no known published study has been done on Asian children. (12) The objectives of this study were to determine the incidence and predictors of emesis in local children undergoing intramuscular (IM) ketamine sedation in the ED of a paediatric tertiary hospital, and to identify high-risk groups, so that antiemetics may be administered prophylactically.…”

“…(10)(11)(12)(13) Among them, ketamine-associated vomiting is the most common adverse event. (13,14) Although not a serious outcome, it is common enough to result in delayed discharge and leads to poor parental satisfaction with sedation. The rate of ketamine-associated emesis in paediatric patients has been reported to be in the range of 6%-28%, depending on the size of the study.…”

Management of Pain in the Emergency Department

“…Second, while data are variable [131,136], the best (and most recent) prospective trial evidence suggests it is worthwhile to coadminister an antisialagogue such as atropine [123]. Third, although postketamine vomiting usually occurs well after ED discharge (and thus well after there is significant risk for aspiration), the occurrence of this "nuisance" side effect may be reduced by postprocedure utilization of an antiemetic such as ondansetron at home (atropine and metoclopramide do not appear to work well for this indication) [137].…”