Pediatric Analgesia and Sedation

Sacchetti, Alfred; Schafermeyer, Robert W.; Gerardi, Michael; Graneto, John; Fuerst, Ronnie S.; Cantor, Richard M.; Santamaria, John; Tsai, Albert Kang; Dieckmann, Ronald A.; Barkin, Roger M.

doi:10.1016/s0196-0644(94)70037-0

Cited by 112 publications

(43 citation statements)

References 105 publications

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“…Emergency physicians already have access to various standards, 36 policies, 47 guidelines, 44,45,48 and review articles 43,49 dealing with the general practice of procedural sedation and analgesia. A central precept of these sources is that procedural sedation and analgesia agents are capable of dose-dependently inducing graded alterations in consciousness ranging anywhere along the ''sedation continuum.''…”

Section: W H Y a S E P A R A T E C L I N I C A L P R A C T I C E G U mentioning

confidence: 99%

Clinical practice guideline for emergency department ketamine dissociative sedation in children

Green¹,

Krauss²

2004

Annals of Emergency Medicine

198

148

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Section: W H Y a S E P A R A T E C L I N I C A L P R A C T I C E G U mentioning

confidence: 99%

Clinical practice guideline for emergency department ketamine dissociative sedation in children

Green¹,

Krauss²

2004

Annals of Emergency Medicine

198

148

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“…3,9,10 At lower doses, ketamine produces solely analgesia and sedation. Once a critical dissociation dosage threshold (approximately 1 -1.5 mg/kg IV or 3 -5 mg/kg IM) is administered, the characteristic trance-like cataleptic state abruptly appears.…”

Section: Discussionmentioning

confidence: 99%

What Is the Optimal Dose of Intramuscular Ketamine for Pediatric Sedation?

Green

Hummel

Wittlake

et al. 1999

Academic Emergency Medicine

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Abstract. Objective: The optimal dose of IM ketamine for ED procedural sedation in children is not known. The authors wished to quantify the doseresponse of ketamine with respect to sedation adequacy, time to discharge, and adverse effects in order to identify an optimal dose. Methods: The study was a consecutive case series of 1,022 children Յ15 years of age given IM ketamine in the EDs of a university medical center and an affiliated county hospital over a nine-year period. Adequacy of sedation, time to discharge, and adverse effects were compared with dose administered. Results: Doses in the sample averaged 3.96 Ϯ 0.69 mg/kg, with a range of 0.48 to 9.09 mg/ kg. Children judged to be adequately sedated received higher doses compared with those inadequately sedated (3.94 Ϯ 0.44 mg/kg vs 3.77 Ϯ 0.49 mg/kg, p = 0.041), and a nonsignificant trend was noted toward uniformly adequate sedation with increasing dose (Յ91% at <4.00 mg/kg, 93% at 4.00 -4.49 mg/kg, and 100% at Ն4.50 mg/kg). No significant difference or trend in time to discharge or adverse effects was noted between the children receiving <4.00 mg/kg and those receiving Ն4.00 mg/kg of ketamine, and the study had power (␣ = 0.05, ␤ = 0.20) to detect a 9-minute difference in times to discharge, a 3.3% difference in rates of airway complications, a 5.6% difference in rates of emesis, and a 12.3% difference in rates of recovery agitation. Conclusion: Ketamine doses of 4 to 5 mg/kg IM produced adequate sedation in 93% -100% of children, suggesting that this dosing range may be optimal for ED procedural sedation. No difference in time to discharge or adverse effects was observed for lower or higher doses. Key words: ketamine; child; sedation; dissociative state; dosing. ACADEMIC EMER- GENCY MEDICINE 1999; 6:21 -26 T HE DISSOCIATIVE agent ketamine is a safe and effective sedative to facilitate the performance of painful and/or emotionally disturbing ED procedures in children. 1 -8 Despite the fact that the majority of the published experience involves the IM route, the optimal dose for IM ketamine has not been previously established. An ideal dose for ketamine should be sufficiently high to reliably produce adequate sedation conditions while still minimizing the time to discharge and the incidence of adverse effects.We previously reported clinical data from a consecutive case series of 1,022 IM ketamine administrations.1 The protocol at the study institutions recommended a dose of 4 mg/kg. Despite this, the treating physicians frequently chose either higher or lower doses at their discretion, and the data set includes a wide range of initial dosing choices (0.48 to 9.09 mg/kg). We analyzed our 1,022-case experience to test the hypotheses that adequacies of sedation, times to discharge, and the incidences of adverse effects differed by ketamine dose administered. Based upon such results, we then hoped to identify an optimal dose. METHODSStudy Design. This was a retrospective analysis of the database of a prospective case series. The study was approved by the ...

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“…The extremes of age provide special challenges to pain care. Pediatric patients and geriatric patients have little in common physiologically, but they share a propensity towards undermedication for pain [19,[72][73][74][75][76][77]. There is some evidence that the undertreatment of pain in those at the extremes of age is improving [78], but the rule for acute care clinicians should be to pay particular attention to pain assessment and care in these patients.…”

Section: Pay Special Attention To Pain Care At the Extremes Ofmentioning

confidence: 99%

Management of Pain in the Emergency Department

Thomas

2013

ISRN Emergency Medicine

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Since pain is a primary impetus for patient presentation to the Emergency Department (ED), its treatment should be a priority for acute care providers. Historically, the ED has been marked by shortcomings in both the evaluation and amelioration of pain. Over the past decade, improvements in the science of pain assessment and management have combined to facilitate care improvements in the ED. The purpose of this review is to address selected topics within the realm of ED pain management. Commencing with general principles and definitions, the review continues with an assessment of areas of controversy and advancing knowledge in acute pain care. Some barriers to optimal pain care are discussed, and potential mechanisms to overcome these barriers are offered. While the review is not intended as a resource for specific pain conditions or drug information, selected agents and approaches are mentioned with respect to evolving evidence and areas for future research.

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Pediatric Analgesia and Sedation

Cited by 112 publications

References 105 publications

Clinical practice guideline for emergency department ketamine dissociative sedation in children

Clinical practice guideline for emergency department ketamine dissociative sedation in children

What Is the Optimal Dose of Intramuscular Ketamine for Pediatric Sedation?

Management of Pain in the Emergency Department

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