Pre‐hospital use of ketamine in paediatric trauma

Abstract

The safe delivery of adequate analgesia and appropriate sedation is a priority in paediatric pre-hospital care. Ketamine was predominantly used in awake non-trapped patients with blunt trauma for procedural sedation and analgesia. Detailed database searches did not demonstrate loss of airway, oxygen desaturation or clinically significant emergence reactions after ketamine administration. This study failed to demonstrate any major side effects of the drug and reassured us that the safety profile of the drug in this environment is likely to be satisfactory. The use of ketamine in trapped children was rare.

Prehospital pain management of injured children: a systematic review of current evidence

“…Five LOE-4 studies, 3 exclusively pediatric, evaluated safety parameters. In a retrospective case series study of 164 children treated with ketamine intravenously or intramuscularly for traumatic injuries, there were no reported adverse cardiovascular or respiratory events [16]. The concomitant use of midazolam in 68% of cases maintained a similar safety profile.…”

A Comparison of Ketamine and Morphine Analgesia in Prehospital Trauma Care: A Cluster Randomized Clinical Trial in Rural Quang Tri Province, Vietnam

“…Three studies of trauma patients from helicopter-based emergency medical services in London and the United Kingdom reported that ketamine may be more appropriate than the opioid analgesics currently used by prehospital providers and that it had a good analgesic effect with few adverse side effects. [9][10][11] The London helicopter emergency medical service reported the administration of ketamine by emergency physicians to 1,030 adult patients, with no significant airway complications observed. In this service, ketamine is used by a physician-paramedic team to provide analgesia and sedation and, rarely, to induce anesthesia.…”

“…7,8 Three studies of trauma patients from helicopter-based emergency medical services in London and the United Kingdom reported that ketamine may be more appropriate than the opioid analgesics currently used by prehospital providers, as it has a good analgesic effect and is associated with few adverse side effects. [9][10][11] In Vietnam, according to the national guidelines for trauma care, morphine and its derivatives are routinely used for prehospital trauma pain relief. To date in Vietnam, ketamine has not been used for trauma pain relief outside hospitals.…”

Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting

“…Most of the evidence addresses ketamine's administration by a variety of routes, for analgesic purposes in adults and children [28][29][30][31][32][33]. Although most studies have emanated from Europe, there are US reviews supporting ketamine use for analgesia administered by HEMS crews [34].…”