Clinical Uses of Ketamine in Children: A Narrative Review

Abstract

Ketamine is a phencyclidine derivative that acts as a noncompetitive N-methyl-D-aspartate as well as a glutamate receptor antagonist. It also has other minor mechanisms that contribute to its extensive drug profile. Ketamine is a bronchodilator and maintains normal airway reflexes and, thus, permits spontaneous respiration. This, coupled with the fact that it produces potent analgesia, makes it highly suitable for children.Despite its many merits, the drug's side effects, along with its cultural image of being a drug of abuse, a drug used in veterinary medicine, or a "date-rape drug" have sullied its reputation within the armamentarium of medicine. Even though it is widely used in developing countries, its use in Western nations has diminished. We have strived to explore the various clinical uses of ketamine in children through this article. In addition, the article also highlights how some of the fears associated with using the drug are unfounded and provides ways by which the drug's side effects can be prevented and managed.

Delayed Sequence Intubation in Children, Why Not?

“…It also preserves spontaneous ventilation and airway tone/reflexes and increases hemodynamic tone, and thus is an agent of choice in heart diseases and shocks. [ 29 30 ]…”

“…Pharmacokinetics of ketamine show high lipid solubility and low plasma protein binding; an onset of action of ≤1 min, distribution half-life of 5–15 min, and elimination half-life of 1–2 h; and with hepatic biotransformation and renal excretion. [ 29 30 ] The recommended doses for sedation in DSI are 1–2 mg/kg in slow bolus (1 min) to avoid potential transient respiratory depression. Maintenance, if required, can be performed with boluses of 0.2–0.5 mg/kg repeated every 10 min or continuous infusion at 5–20 μg/kg/min [ Table 1 ].…”

“…Maintenance, if required, can be performed with boluses of 0.2–0.5 mg/kg repeated every 10 min or continuous infusion at 5–20 μg/kg/min [ Table 1 ]. [ 29 30 ]…”

Trends in sedation‐analgesia practices in pediatric liver transplant patients admitted postoperatively to the pediatric intensive care unit: An analysis of data from the pediatric health information system (PHIS) database

“…It is also noteworthy that there is an increasing trend in the use of ketamine within this patient cohort, which is not surprising given the safe use of ketamine in other critically ill PICU patients for analgesia, sedation, amnesia due to ketamine's ability to maintain patient hemodynamics and airway reflexes. 29 One large single-center pediatric study, Sperotto et al reported on safe use of prolonged ketamine infusions for analgosedation especially in patients who respond poorly to conventional drugs. Additionally, the authors' reported on the reduction in dosages of opioids as well as no increases in the dosages of other analgosedation drugs in the 24 h after introduction of ketamine infusion.…”

Efficacy of intraoperative subanesthetic dose of ketamine/esketamine in preventing postoperative cognitive dysfunction: a systematic review and meta-analysis

“…14 These mechanisms have shown efficacy in mitigating the incidence of POCD. 15 Ketamine is a versatile drug that has been widely used since the 1970s and is commonly employed for intraoperative anesthesia and adjunctive perioperative analgesia, 16 and it is commonly used for children 17 and burn victims, owing to its favorable cardiovascular characteristics and ability to reduce glandular secretion. 18 However, ketamine demonstrates sympathomimetic effects, including increased sympathetic activity, cardiac contractility, and heart rate, 19 while it may also aggravate psychiatric symptoms.…”