The use of esketamine sedation in the emergency department for manipulation of paediatric forearm fractures: A 5 year study

Patel, Dhawal; Talbot, Christopher; Luo, Weisang; Mulvaney, Shirley; Byrne, E

doi:10.1016/j.injury.2020.12.033

Cited by 12 publications

(7 citation statements)

References 20 publications

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“…Pretreatment with intravenous injection of esketamine before induction can reduce the degree of pain on the rst day after the operation, reduce the level of validation factors in children, and do not increase adverse reactions. The economy and effectiveness of esketamine for children can be fully guaranteed [21]. IL-6 can be detected in the systemic circulation 60 min after trauma, and its peak value is between 4 and 6 h. IL-6 induces the body to produce acute phase reaction protein, causing the increase in serum CRP level.…”

Section: Discussionmentioning

confidence: 99%

Effects of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy

zhu

Wang

et al. 2023

Preprint

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Background This study aimed to observe the effect of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy. Methods Eighty children scheduled for tonsillectomy and adenoidectomy were randomly divided into two groups using a random number table: esketamine group (S-ketamine group, n = 40) and control group (control group, n = 40). Before anesthesia induction, the S-ketamine group received an intravenous injection of esketamine at 0.5 mg/kg, whereas the control group was given the same dose of sodium chloride injection. For the maintenance of anesthesia, the S-ketamine group was treated with propofol of 8–12 mg/kg/h, remifentanil of 0.1–0.4 µg/kg/min, and esketamine of 0.125 mg/kg/h, while the control group was treated with propofol of 8–12 mg/kg/h and remifentanil of 0.1–0.4 µg/kg/min. Both groups were treated with intravenous inhalation combined with general anesthesia. The operation time, recovery time, postanesthesia care unit (PACU) stay time, and adverse reactions within 48 h after operation were observed and recorded. The face, legs, activity, cry, and consolability (FLACC) pain scale score was evaluated at 15 min (T1), 1 h (T2), 6 h (T3), 12 h (T4), 24 h (T5), and 48 h (T6) after the operation. The emergence agitation score (pediatric anesthesia emergence delirium [PAED]) was evaluated in 15 min (T1) and 1 h (T2) after the operation. The plasma C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations were measured at T0 and T3. Results There were no significant differences in operation time, recovery time, and PACU stay time between the two groups (p > 0.05). At T1, T2, T3, T4, and T5, the FLACC pain scores of the S-ketamine group were significantly lower than those of the control group (p < 0.05). The PAED scores at T1 and T2 in the S-ketamine group were significantly lower than those in the control group. Compared with T0, the plasma CRP and IL-6 concentrations at T3 in the two groups were significantly increased (p < 0.05), but the increase in the S-ketamine group was significantly smaller than that in the control group (p < 0.05). There was no significant difference in the incidence of postoperative adverse reactions between the two groups (p > 0.05). Conclusion Esketamine used in pediatric tonsillectomy and adenoidectomy can effectively reduce postoperative FLACC, PAED score, and levels of inflammatory factors without increasing adverse reactions.

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Section: Discussionmentioning

confidence: 99%

Effects of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy

zhu

Wang

et al. 2023

Preprint

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“…Van de Bunt and colleagues reported that procedural sedation with esketamine was effective and safe for children undergoing hydrostatic reduction for ileocolic intussusception [ 35 ]. Another retrospective study suggested that esketamine sedation for manipulation of pediatric forearm fractures in the emergency department led to acceptable patient outcomes, without adverse events following esketamine administration [ 36 ]. Similar to our results, a recent randomized study showed that a low-dose esketamine adjunct to propofol sedation in adult patients undergoing endoscopic retrograde cholangiopancreatography reduced the total amount of propofol, without affecting recovery time, patient and endoscopist satisfaction, or cardiorespiratory adverse events [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial

Shan

Gao

et al. 2022

Eur J Med Res

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Background Adequate sedation is essential for pediatric patients undergoing 3Tesla (T) magnetic resonance imaging (MRI). Using propofol alone is associated with patient arousing and adverse airway events. This study aimed to assess esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3 T MRI. Methods In this randomized, double-blind, controlled trial, 114 pediatric patients aged between 6 months and 8 years were randomly assigned, in a 1:1 ratio, to the esketamine–propofol group or the dexmedetomidine–propofol group. Sedation was provided with esketamine or dexmedetomidine in combination with propofol titration. The primary outcome was the total dose of propofol. Secondary outcomes included propofol infusion dose, adverse events, time to emergence from sedation, and time to discharge from recovery room. Results A total of 111 patients completed this study (56 in the esketamine–propofol group and 55 in the dexmedetomidine–propofol group). All MRI procedures were successfully performed under sedation. The total median (IQR) dose of propofol was significantly lower in the esketamine–propofol group (159.8 [121.7, 245.2] μg/kg/min) than that in the dexmedetomidine–propofol group (219.3 [188.6, 314.8] μg/kg/min) (difference in medians [95% CI] = − 66.9 [− 87.8 to − 43.0] μg/kg/min, P < 0.0001). The use of esketamine resulted in a lower dose of propofol for titration (difference in medians [95% CI] = − 64.3 [− 75.9 to − 51.9] μg/kg/min), a shorter time to emergence (difference in means [95% CI] = − 9.4 [− 11.4 to − 7.4] min), and a reduced time to recovery room discharge (difference in means [95% CI] = − 10.1 [− 12.1 to − 8.2] min). In the dexmedetomidine–propofol group, 2 patients experienced upper airway obstruction and 6 patients had bradycardia. No episodes of oxygen desaturation or other adverse events were observed. Conclusions Although both regimens provided effective sedation for pediatric 3 T MRI, the esketamine–propofol sedation reduced propofol requirement and facilitated recovery, without detection of increased adverse effects in the studied population. Trial registration Chinese Clinical Trial Registry (identifier: ChiCTR2100048477).

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“…In 2021, Xin et al performed a prospective study and found that intranasal esketamine at 0.5 mg/kg was similar to a high dose of dexmedetomidine at 2.0 µg/kg in terms of sedation onset time and analgesia in children for dental surgery [16]. Another retrospective study analyzed the sedation procedure with intravenous esketamine in 151 pediatric patients with forearm fractures and showed that esketamine was a safe and effective medication during fracture reduction [17]. During the procedure sedation for intussusception reduction in children, 0.5-1 mg.kg − 1 intravenous esketamine was also shown to have better e cacy and similar safety to morphine [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of oral esketamine on preoperative sedation and venipuncture analgesia in pediatric patients: a prospective randomized double-blind controlled clinical trial

Liu

Wang

Liu

et al. 2022

Preprint

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Background Anxiety and uncooperation are common among pediatric patients during the preoperative preparation, which requires adequate and appropriate analgesia and sedation. Methods We performed a prospective, randomized, double-blind, controlled clinical trial involving 1–6-year-old pediatric patients scheduled for elective tonsillectomy or adenoidectomy between December 2020 and May 2021. Patients were randomly assigned to control (group C), esketamine 1 mg.kg− 1 (group EK1), or esketamine 2 mg.kg− 1 (group EK2) group. Venipuncture analgesia, cooperation, and sedation, as well as satisfaction upon parent–child separation, cooperation, sedation, and adverse events, were compared among the three groups. Dynamic changes in the sedation score and vital signs were monitored. Results A total of 88 pediatric patients were analyzed, with 29, 29, and 30 patients in groups C, EK1, and EK2, respectively. Compared with group C, groups EK1 and EK2 both had better analgesia during venipuncture (P < 0.001). In addition, better cooperation and sedation was noticed in groups EK1 and EK2 during parent–child separation and venipuncture than in group C. Compared with the baseline, the mean respiratory rate had a significant decrease from 25.6 ± 0.3 to 24.6 ± 0.4 breaths/min at 30 min after the esketamine administration in group EK2, although it was still within normal limits (P = 0.030). There were no significant differences in adverse events among three groups. Conclusions Preoperative oral administration of 1 or 2 mg.kg− 1 esketamine in pediatric patients could achieve effective analgesia and sedation. Oral medication of 2 mg.kg− 1 esketamine had more pronounced effects. Trial registration : This clinical trial was registered at the Chinese Clinical Trial Registry (ChiCTR2000040739) on 08/12/2020.

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The use of esketamine sedation in the emergency department for manipulation of paediatric forearm fractures: A 5 year study

Cited by 12 publications

References 20 publications

Effects of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy

Effects of esketamine on postoperative pain and inflammatory factors in children undergoing tonsillectomy and adenoidectomy

Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial

Effect of oral esketamine on preoperative sedation and venipuncture analgesia in pediatric patients: a prospective randomized double-blind controlled clinical trial

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