Procedural Sedation Outside of the Operating Room Using Ketamine in 22,645 Children: A Report From the Pediatric Sedation Research Consortium*

Abstract

Objective-Most studies of ketamine administered to children for procedural sedation are limited to emergency department use. The objective of this study was to describe the practice of ketamine procedural sedation outside of the operating room and identify risk factors for adverse events.Design-Observational cohort review of data prospectively collected from 2007 to 2015 from the multicenter Pediatric Sedation Research Consortium.Setting-Sedation services from academic, community, free-standing children's hospitals and pediatric wards within general hospitals.Patients-Children from birth to 21 years old or younger. Interventions-None.Measurements and Main Results-Describe patient characteristics, procedure type, and location of administration of ketamine procedural sedation. Analyze sedation-related adverse Drs, Grunwell and Kamat conceived and developed the study and wrote the article. Drs. Travers and McCracken conducted statistical analyses and edited the article. Drs. Scherrer, Stormorken, Chumpitazi, Roback, and Stockwell edited the article. All authors read and approved the article.Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/pccmjournal).The remaining authors have disclosed that they do not have any potential conflicts of interest. Conclusions-This is a description of a large prospectively collected dataset of pediatric ketamine administration predominantly outside of the operating room. The overall incidence of severe adverse events was low. Risk factors associated with increased odds of adverse events were as follows: cardiac and gastrointestinal disease, lower respiratory tract infection, and the coadministration of propofol and anticholinergics. HHS Public AccessKeywords adverse events; ketamine; laryngospasm; pediatric procedure sedation; risk factorsThere is a growing demand to provide procedural sedation (PS) for children outside of the operating room (OR). Subspecialists such as intensivists, emergency medicine physicians, anesthesiologists, and hospitalists, all provide PS for children. Ketamine has been used by emergency medicine physicians for well over 2 decades for primarily painful procedures (1-13). We used the Pediatric Sedation Research Consortium (PSRC) database to describe the administration of ketamine during PS, characterize the adverse events (AEs), and identify the risk factors associated with AEs or severe AEs (SAEs). Based on previous studies, we hypothesized that age less than 12 months or greater than 13 years, coadministration of anticholinergics or benzodiazepines, lower respiratory tract illness, and American Society of Anesthesiologists-Physical Status (ASA-PS) greater than or equal to III would be associated with an AEs (12,(14)(15)(16)(17). METHODS Study Design and Data CollectionThis study is an observational cohort review of prospectively collected data obtained from the multicenter PSRC dat...

Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

“…The dataset presented is a subanalysis of a larger patient cohort who received ketamine for pediatric PS in the PSRC dataset (5). PSRC data collection methodology has been reported in several publications (3, 5, 16,18).…”

“…The dataset presented is a subanalysis of a larger patient cohort who received ketamine for pediatric PS in the PSRC dataset (5). PSRC data collection methodology has been reported in several publications (3, 5, 16,18). The PSRC currently comprised 44 self-selected institutions that include both free-standing children’s hospitals and pediatric wards within general hospitals that are also academic and community-based hospitals (eTable 1, Supplemental Digital Content 1, http://links.lww.com/PCC/A473).…”

“…The PSRC a priori defined AE (eTable 2, Supplemental Digital Content 1, http://links.lww.com/PCC/A473) and SAE (5, 19). Although multiple AE or SAE could occur within a single course of sedation, the AE and SAE rates were reported as the number of sedations in which at least one AE or SAE occurred out of the total number of sedations.…”

“…Large cohort studies have described outcomes of PS using propofol or ketamine for children undergoing radiologic imaging studies and painful procedures such as a fracture or joint reduction, laceration repair, and incision and drainage of an abscess (1–5). The combination of ketamine and propofol, sometimes referred to as “ketofol,” has been used widely in the emergency department (ED) (5–9). …”

“…Previously, the PSRC database has been used to report on the demographics, success, and adverse sedation-related events associated with a variety of PS medication regimens (3,5,15–17). We used the PSRC database to describe the patient, procedure, and sedation regimen characteristics, adverse event (AE) profile, and risk factors associated with increased odds of AEs or serious AEs (SAEs) in a subcohort of patients receiving the combination of ketamine + propofol for PS.…”