Sedation with the Combination of Ketamine and Propofol in a Pediatric ED: A Retrospective Case Series Analysis

Scheier, Eric; Gadot, Chen; Leiba, Ronit; Shavit, Itai

doi:10.1016/j.ajem.2015.03.033

Cited by 22 publications

(36 citation statements)

References 12 publications

(19 reference statements)

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“…In most pediatric emergency rooms, invasive procedures are performed using ketamine or propofol, the latter alone or in combination with an opioid. 23 The prolonged induction and recovery time may be a deterrent to liberal use of DEX as a sole sedation agent in the busy pediatric emergency department (ED), in which quick patient turnover is necessary. 24 Furthermore, there are not many radiology studies (especially MRIs) requiring deep sedation performed on patients within the ED setting, and it is unlikely that the majority of radiologic procedures performed were for emergency department patients.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Procedural Sedation Using Dexmedetomidine: A Report From the Pediatric Sedation Research Consortium

Sulton

McCracken

Simon³

et al. 2016

Hospital Pediatrics

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Section: Discussionmentioning

confidence: 99%

Pediatric Procedural Sedation Using Dexmedetomidine: A Report From the Pediatric Sedation Research Consortium

Sulton

McCracken

Simon³

et al. 2016

Hospital Pediatrics

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“…The procedure is performed under deep sedation provided by an emergency physician. 13 Patients with fractures in an acceptable radiologic alignment after reduction are discharged and instructed to return to the orthopedic clinic within 5-7 days or to the ED if they experience CstRP. Prior to ED discharge, patients and caregivers receive an explanation about the possibility of CstRP and are asked to return to the ED for reevaluation if CstRP or other symptoms of neurovascular injury present.…”

Section: Ed Casting Protocolmentioning

confidence: 99%

<p>Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures</p>

Kvatinsky

Carmiel

Leiba

et al. 2020

JPR

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Background: Cast immobilization is the primary treatment for children with forearm fractures. After emergency department (ED) discharge, some patients develop cast-related pain (CstRP) around the distal part of the upper extremity. We examined variables associated with ED revisits due to CstRP in children with forearm fractures. Methods: A retrospective cohort study of all children who were treated with cast immobilization for forearm fracture over a 7-year period was conducted. Patient demographics, fracture location, casting method (below elbow/above elbow), first visit pain scores, treatment with fracture reduction, and revisit data were collected. Multivariate regression was used to identify predictors of revisits due to CstRP within 72 hrs post-discharge. Results: A total of 2307 children were treated with cast immobilization; 95 (4.2%) revisited the ED due to CstRP (median pain score 7, interquartile range 5-9). No patient had neurovascular compromise or required surgery or re-reduction. Fifty-eight (61.1%) patients were treated with cast splitting, 10 (10.5%) with trimming, and 27 (28.4%) with cast replacement. Variables on first visit that were associated with increased odds for ED revisit included treatment with fracture reduction (odds ratio [OR] 2.31; 95% confidence interval [CI] 1.58-3.36) and a median pain score of 6 or more upon ED presentation (OR 1.57; 95% CI 1.32-2.13). Discussion: A small number of children with forearm fractures revisited the ED due to CstRP. Study findings suggest that being treated with closed reduction and having a pain score ≥ 6 on the first visit were associated with ED revisit due to CstRP.

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“…This is performed for adult procedural sedation in the ED because the opposing physiological effects of ketamine and propofol are beneficial during emergency situations -ketamine mitigates propofol-induced hypotension, and propofol mitigates ketamine-induced vomiting and recovery agitation [53] . Accordingly, a retrospective case analysis suggested that sedation with the combination of ketamine and propofol can be safely performed in the pediatric ED by a skilled emergency physician [54] . The use of ketamine, 1.0 mg/kg iv followed by 0.5 mg/kg every 3 min as needed, was safe and effective for procedural sedation [55] .…”

Section: Use Outside the Operating Roommentioning

confidence: 99%

Ketamine use in current clinical practice

2016

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After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

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Sedation with the Combination of Ketamine and Propofol in a Pediatric ED: A Retrospective Case Series Analysis

Cited by 22 publications

References 12 publications

Pediatric Procedural Sedation Using Dexmedetomidine: A Report From the Pediatric Sedation Research Consortium

Pediatric Procedural Sedation Using Dexmedetomidine: A Report From the Pediatric Sedation Research Consortium

<p>Emergency Department Revisits Due to Cast-Related Pain in Children with Forearm Fractures</p>

Ketamine use in current clinical practice

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