Ketamine use for management of vaso‐occlusive pain in pediatric sickle cell disease

Abstract

Background Typical sickle cell disease (SCD) vaso‐occlusive pain episode (VOE) management includes opioids, which are often inadequate and can be associated with significant side effects. Ketamine, a dissociative anesthetic, is a potentially effective adjunct to VOE management. Objectives This study aimed to characterize ketamine use for VOE management in pediatric SCD. Method This retrospective case series summarizes a single‐center experience regarding the use of ketamine for inpatient management of pediatric VOE in 156 admissions from 2014 to 2020. Results Continuous low‐dose ketamine infusion was most commonly prescribed to adolescents and young adults as an adjunct to opioids (median starting dose 2.0 μg/kg/min; median maximum dose 3.0 μg/kg/min). Ketamine was started a median of 13.7 hours after admission. Median ketamine infusion duration was 3 days. In most encounters, ketamine infusion was discontinued prior to opioid patient‐controlled analgesia (PCA) discontinuation. The majority of encounters (79.3%) had a reduction in either PCA dose, continuous opioid infusion, or both while receiving ketamine. Low‐dose ketamine infusion was associated with side effects noted in 21.8% (n = 34) of encounters. The most common side effects included dizziness (5.6%), hallucinations (5.1%), dissociation (2.6%), and sedation (1.9%). There were no reports of ketamine withdrawal. Most patients who received ketamine went on to receive it again during a subsequent admission. Conclusion Further study is needed to determine the optimal timing of ketamine initiation and dosing. The variability of ketamine administration highlights the need for standardized protocols for ketamine use in VOE management.

Reply to: Comment on: Ketamine use for management of vaso‐occlusive pain in pediatric sickle cell disease

“…To the Editor We thank Dr. Qureshi for their thoughtful letter 1 in response to our publication. 2 We greatly appreciate the interest and enthusiasm in our publication and feel that it has allowed us to provide further insights into the use of ketamine in children with sickle cell disease (SCD) presenting with acute vaso-occlusive episodes (VOE). We address some of the comments raised by Dr. Qureshi below.…”

“…This study was conducted as retrospective chart review, therefore the IRB determined that this study did not require patient consent. Carolina Donado 3,4 Natasha M. Archer 1,2…”