Procedural sedation for pediatric patients in the emergency department at King Khalid University Hospital, Riyadh, K.S.A

Salleeh, Hashim M. Bin; Ahmadi, Tahani Al; Mujawar, Quais

doi:10.4103/0974-2700.136862

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Ketamine is an analgesic that has been shown to help to decrease acute pain in the ED . With the morbidity and mortality associated with the ongoing opioid epidemic, there is an urgent need to find nonopioid alternatives to treat pain that are safe and effective . Our study demonstrated efficacy for SDDK at 0.5 and 0.25 mg/kg infused over 20 minutes to reduce pain in our population of chronic pain patients during their ED stay.…”

Section: Discussionmentioning

confidence: 74%

Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain

Lumanauw

Youn

Horeczko

et al. 2019

Academic Emergency Medicine

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Background: Subdissociative-dose ketamine (SDDK) is used to treat acute pain. We sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain.Methods: This study was a randomized double-blind placebo-controlled trial conducted May 2017 to June 2018 at a public teaching hospital (ClinicalTrials.gov #NCT02920528). The primary endpoint was a 20-mm decrease on a 100-mm visual analog scale (VAS) at 60 minutes. Power analysis using three groups (0.5 mg/kg ketamine, 0.25 mg/kg ketamine, or placebo infused over 20 minutes) estimated that 96 subjects were needed for 90% power. Inclusion criteria included age > 18 years, chronic pain > 3 months, and acute exacerbation (VAS ≥ 70 mm). Pain, agitation, and sedation were assessed by VAS at baseline and 20, 40, and 60 minutes after initiation of study drug. Telephone follow-up at 24 to 48 hours used a 10-point numeric rating scale for pain.Results: A total of 106 subjects were recruited, with three excluded for baseline pain < 70 mm. After randomization, 35 received 0.5 mg/kg ketamine, 36 received 0.25 mg/kg ketamine, and 35 received placebo. Three subjects receiving 0.5 mg/kg withdrew during the infusion due to adverse effects, and one subject in each group had incomplete data, leaving 97 for analysis. Initial pain scores (91.9 AE 8.9 mm), age (46.5 AE 12.6 years), sex distribution, and types of pain reported were similar. Primary endpoint analysis found that 25 of 30 (83%) improved with 0.5 mg/kg ketamine, 28 of 35 (80%) with 0.25 mg/kg ketamine, and 13 of 32 (41%) with placebo (p = 0.001). More adverse effects occurred in the ketamine groups with one subject in the 0.25 mg/kg group requiring a restraint code for agitation. A total of 89% of subjects were contacted at 24 to 48 hours, and no difference in pain level was detected between groups.Conclusion: Ketamine infusions at both 0.5 and 0.25 mg/kg over 20 minutes were effective in treating acute exacerbations of chronic pain but resulted in more adverse effects compared to placebo. Ketamine did not demonstrate longer-term pain control over the next 24 to 48 hours.

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Section: Discussionmentioning

confidence: 74%

Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain

Lumanauw

Youn

Horeczko

et al. 2019

Academic Emergency Medicine

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“…According to the results presented in that study, adverse events were witnessed in 10 patients, of which six out of the nine patients that received ketamine for procedural sedation vomited [22].…”

Section: Discussionmentioning

confidence: 98%

“…Similarly, a previous study that commonly used ketamine for procedural sedation reported that vomiting and nausea were the most common adverse events observed in the patients. According to the results presented in that study, adverse events were witnessed in 10 patients, of which six out of the nine patients that received ketamine for procedural sedation vomited [ 22 ].…”

Section: Reviewmentioning

confidence: 99%

Comparing the Safety and Effectiveness of Ketamine Versus Benzodiazepine/Opioid Combination for Procedural Sedation in Emergency Medicine: A Comprehensive Review and Meta-Analysis

Zaki¹,

Ibrahim²,

Osman³

et al. 2023

Cureus

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Procedural sedation is essential in the ED to conduct painful procedures effectively. Ketamine and benzodiazepines/opioids are commonly used, with ketamine providing adequate analgesia and preserving airway muscle tone. However, ketamine is associated with adverse effects while benzodiazepines/opioids can lead to respiratory depression. This study compares the safety and efficacy of ketamine and midazolam/fentanyl. Two search methods were used to identify studies related to our topic, including a database search and a manual search involving screening reference lists of articles retrieved by the database search. A methodological quality appraisal was conducted on the articles suitable for inclusion using Cochrane's risk of bias tool in the Review Manager software (Review Manager (RevMan) (Computer program). Version 5.4, The Cochrane Collaboration, 2020). Moreover, pooled analysis was performed using the Review manager software.The study analyzed 1366 articles, of which seven were included for analysis. Pooled data showed that ketamine and midazolam/fentanyl had similar effects on pain scores during procedures and sedation depth measured by the University of Michigan sedation scale. However, the Modified Ramsay Sedation Score showed significantly more profound sedation in the ketamine group. The only significant adverse events were vomiting and nausea, which had a higher incidence in the ketamine group.Our data suggest that ketamine is as effective as the midazolam/fentanyl combination for procedural sedation but is associated with higher incidences of adverse events. Therefore, midazolam/fentanyl can be recommended for procedural sedation in the ED. However, it should be provided in the presence of a physician comfortable with airway management due to high incidences of oxygen desaturation.

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“…Ozkan et al22 reported 12.1% nausea and 7.9% vomiting during their practice of elective surgery in the pediatric population. Salleeh et al23 used ketamine in 179 pediatric emergency patients for painful and traumatic, diagnostic and therapeutic procedures and reported 60% of vomiting to be the most frequently observed side effect. In our study 30 patients in Group 1 (3.3%) had nausea in line with literature, but we did not come across vomiting.…”

Section: Discussionmentioning

confidence: 99%

Pediatric tooth extractions under sedoanalgesia

Arpacı¹,

Işık²

2016

Pak J Med Sci

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Objective:The present study aims to evaluate intravenous ketamine and inhalation sedation in children, their unwanted side-effects and surgeon satisfaction.Methods:In this study, data of 922 children aged between 1-18 who underwent tooth extraction under sedoanalgesia in our department between September 2015-January 2016 were gathered and anesthesia approaches, unwanted side effects and surgical satisfaction was investigated. Postoperative recovery emergence agitation or delirium was evaluated with Watcha Behavior Scale (WBS).Results:Patients were grouped and compared according to acceptance of intravenous line placement (Group-1) or not (Group- 2). Group 1 received intravenous ketamine anesthesia (n=822), Group 2 received inhalation anesthesia with sevoflurane (n=100). Number of patients, age, weight and gender was significantly different in two groups. When side effects were investigated nausea was observed in 30 patients (3.6%), skin rashes were observed in 26 patients (3.2%) in Group-1 while skin rashes were observed in one patient (1%) in Group 2. 95% of surgeons reported intravenous anesthesia, 18% of surgeons reported inhalation anesthesia to be the anesthesia of choice. Emergence of postoperative recovery agitation (WBS≥3) was observed more frequent in Group 2 (p<0.05) than Group 1.Conclusion:Ketamine, which has analgesic, hypnotic and amnestic effects and which does not alter pharyngeal and laryngeal reflexes thus minimizes aspiration possibility, is a safe and effective anesthetic agent for tooth extractions of the pediatric population under sedoanalgesia.

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Procedural sedation for pediatric patients in the emergency department at King Khalid University Hospital, Riyadh, K.S.A

Cited by 5 publications

References 20 publications

Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain

Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain

Comparing the Safety and Effectiveness of Ketamine Versus Benzodiazepine/Opioid Combination for Procedural Sedation in Emergency Medicine: A Comprehensive Review and Meta-Analysis

Pediatric tooth extractions under sedoanalgesia

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