Ketamine Sedation After Administration of Oral Contrast: A Retrospective Cohort Study

Teshome, Getachew; Braun, Janet L.; Lichenstein, Richard

doi:10.1542/hpeds.2014-0200

Cited by 4 publications

(4 citation statements)

References 31 publications

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“…Procedural sedation is regularly performed in other settings in which fasting is frequently incomplete: cardiac catheterisation [80]; therapeutic abortions [81]; eye surgery [82][83][84][85]; and abdominal imaging in children who have first received oral contrast [86][87][88]. None of these settings have been identified as showing an increased aspiration risk.…”

Section: Absent Risk Factorsmentioning

confidence: 99%

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Green¹,

Leroy

Roback

et al. 2019

Anaesthesia

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The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to 374 This statement presents the first fasting and aspiration prevention recommendations specific to procedural sedation.

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Section: Absent Risk Factorsmentioning

confidence: 99%

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Green¹,

Leroy

Roback

et al. 2019

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Some studies have found no apparent association between aspiration and noncompliance with fasting recommendations in children ( 56 , 57 ). In addition, fasting is regularly incomplete before procedural sedation in other settings, such as coronary interventions, oral contrast ( 58 ) and eye surgery ( 59 ), and no increased aspiration risk has been shown in the above settings. Given the low observed frequency of aspiration, fasting strategies in procedural sedation can reasonably be less restrictive ( 55 ).…”

Section: Discussionmentioning

confidence: 99%

Parental preferences for the procedural sedation of children in dentistry: a discrete choice experiment

Zhuge,

Zheng,

et al. 2023

Front. Pediatr.

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PurposeThe aim of this study was to explore parental preferences for the procedural sedation of children in dentistry through a discrete choice experiment (DCE) to inform clinical decisions and oral health management.MethodsBased on literature reviews, interviews with parents of pediatric dental patients, and expert consultation, six attributes, including fasting time, recovery time, sedative administration routes, adverse reactions, sedation depth and procedure cost, were incorporated into the DCE questionnaire. The DCE questionnaire collected data on parental preferences for pediatric dental sedation treatment from June to August 2022. A conditional logit model was used to analyze preference and willingness to pay (WTP) for each attribute and its level. Subgroup analyses assessing the impact of parents' dental anxiety on procedural sedation preferences were also conducted using conditional logit models.ResultsA total of 186 valid questionnaires were gathered. Parents' preferences for fewer adverse reactions, a milder sedation depth, lower out-of-pocket cost, shorter fasting and recovery times and administration by inhalation were significantly associated with their choice of sedation model. The conditional logit model showed that parents were most interested in treatments with no adverse reactions (0% vs. 15%) (Coef, 1.033; 95% CI, 0.833–1.233), followed by those providing minimal sedation (vs. deep sedation) (Coef, 0.609; 95% CI, 0.448–0.769). Moreover, the relative importance of adverse reactions and fasting time was higher among anxious than nonanxious parents. The study found a WTP threshold of ¥1,538 for reducing adverse reactions (15% to 0%). The WTP threshold for the best sedation procedure scenario (no fasting requirement, 10 min recovery time, administration by inhalation, 0% adverse reaction incidence and minimal sedation) was ¥3,830.ConclusionReducing the adverse reactions and depth of sedation are predominant considerations for parents regarding procedural sedation in pediatric dentistry, followed by lower cost, shorter fasting and recovery times and inhalation sedation. Parents with dental anxiety had a stronger preference for options with a lower incidence of adverse reactions and shorter fasting time than parents without dental anxiety. This discovery is helpful for doctors and can promote collaborative decision-making among parents and doctors.

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“…We analyzed fasting duration beyond reported criteria [ 8 , 12 ]. Another recent study found that fasting duration was significantly related to adverse events, especially vomiting, although hypoxia was not [ 10 ]. A future study investigating the depth of sedation in more subjects would be valuable for understanding the relationship between fasting duration and adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…One of the most worrying adverse events associated with sedatives is tracheal aspiration of regurgitated food; therefore, guidelines suggest that sedatives or analgesics should be administered on an empty stomach [ 8 ]. However, although many institutions follow this guideline, several recent studies have reported that no association exists between preprocedural fasting state and adverse events from sedation [ 9 , 10 ]. In addition, the clinical policy of the American College of Emergency Physicians published in 2014 recommended proceeding with sedation in the ED regardless of the fasting state, since preprocedural fasting does not reduce the risk of vomiting or aspiration [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Considerations for physicians using ketamine for sedation of children in emergency departments

Kim

Choi

et al. 2017

Clin Exp Emerg Med

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ObjectiveKetamine use in emergency departments (EDs) for procedural sedation and analgesia is becoming increasingly common. However, few studies have examined patient factors related to adverse events associated with ketamine. This study investigated factors for consideration when using ketamine to sedate pediatric ED patients.MethodsThe study included pediatric patients receiving ketamine for laceration repair in the ED. Before sedation, information was collected about upper respiratory tract infection symptoms, allergy history, and fasting time. Patients received 2 mg/kg ketamine intravenously or 4 mg/kg ketamine intramuscularly. The primary outcomes were adverse events due to ketamine.ResultsWe studied 116 patients aged 8 months to 7 years (2.8±1.5 years). The group with adverse events was significantly younger on average than the group without adverse events (2.5±1.5 vs. 3.1±1.5, P=0.028). Upper respiratory tract infection symptoms were not significant variables affecting ketamine sedation (48.9% vs. 43.7%, P=0.719). There was no significant association between duration of fasting and adverse events (P=0.073 and P=0.897, respectively), or between food type and adverse events (P=0.734). However, the number of attempts to sedate and ketamine dose correlated with adverse events (P<0.001 and P=0.022, respectively). In multiple logistic regression analysis, intravenous injection and ketamine dose were significant factors (odds ratio, 16.77; 95% confidence interval, 1.78 to 498.54; odds ratio, 4.37; 95% confidence interval, 1.59 to 22.9, respectively).ConclusionEmergency medicine physicians should consider injection type and ketamine dose when using ketamine sedation while suturing lacerations.

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Ketamine Sedation After Administration of Oral Contrast: A Retrospective Cohort Study

Abstract: Children who received oral contrast up to 58 minutes before ketamine sedation had a higher rate of vomiting than those who did not receive oral contrast. We did not identify cases of clinical aspiration, and the incidence of hypoxia between the 2 groups was not statistically significant.

Cited by 4 publications

References 31 publications

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Parental preferences for the procedural sedation of children in dentistry: a discrete choice experiment

Considerations for physicians using ketamine for sedation of children in emergency departments

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