Use of Ketamine Continuous Infusion for Pediatric Sedation in Septic Shock

Barbi, Egidio; Rizzello, Elisa; Taddio, Andrea

doi:10.1097/pec.0b013e3181f196e6

Cited by 8 publications

(10 citation statements)

References 5 publications

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“…However, 33 articles were excluded because they were conducted outside of the ED or PICU, used for a different indication, or did not provide a thorough description of the ketamine CIN regimen; 11 case reports and studies of children receiving a ketamine CIN were included in the analysis. 9-19 Table 1 provides a summary of the type of report, ketamine CIN dosing regimen and duration of administration, and whether the dose was tapered.…”

Section: Overview Of Literaturementioning

confidence: 99%

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Ketamine Continuous Infusions in Critically Ill Infants and Children

et al. 2016

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Section: Overview Of Literaturementioning

confidence: 99%

“…Barbi et al 10 describe a case of using ketamine for sedation and analgesia in an 11-year-old boy with septic shock secondary to meningococcus. Initially, this child was placed on a midazolam CIN that was titrated to 0.18 mg/kg/h.…”

Section: Overview Of Literaturementioning

confidence: 99%

Ketamine Continuous Infusions in Critically Ill Infants and Children

et al. 2016

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“…►Table 2 provides a description of published dosing for this indication, with doses ranging from 1.2 to 100 µg/kg/min (►Table 2). [3][4][5][6][7][8][9][10][11][12] However, most of these reports do not describe initial or peak ketamine doses. The duration of use in nine of these reports ranged from 12 to 153 hours.…”

Section: Discussionmentioning

confidence: 99%

“…2 Several reports have described the use of prolonged infusions of ketamine in mechanically-ventilated children as part of their sedation and analgesia regimen. [3][4][5][6][7][8][9][10][11][12] The duration of use in these studies varied from 12 to 408 hours. Common adverse events of ketamine include hypertension, tachycardia, emergence phenomenon, and increased secretions.…”

Section: Introductionmentioning

confidence: 99%

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Extended Duration Ketamine Infusions in Critically Ill Children: A Case Report and Review of the Literature

Moore

PharmD

Harkin

et al. 2020

J Pediatr Intensive Care

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Ketamine is an N-methyl-D-aspartate receptor antagonist that has been used as an adjunct analgesic and sedative in critically ill children. Previous reports noted that ketamine has been used for a variable duration of 12 to 408 hours for this indication. We report on the use of ketamine infusions for >720 hours as a second-line sedative in addition to an opioid and dexmedetomidine infusion in a 2-month old and 17-month old. The purpose of this case report and review of the literature is to highlight the prolonged ketamine exposure of these two patients and to provide awareness to clinicians on the potential of withdrawal with extended ketamine administration. These children were started on initials doses of 5 and 15 µg/kg/min and titrated to peak doses of 20 and 25 µg/kg/min, respectively. They were continued for a total of 987 and 792 hours, respectively. No adverse events were noted during the ketamine infusions. One patient developed possible withdrawal symptoms 17 hours after ketamine discontinuation despite tapering of the infusion. These symptoms resolved with administration of as needed intravenous opioids and benzodiazepines, and the agitation normalized within 24 hours after ketamine discontinuation. Clinicians should consider tapering ketamine infusions in children receiving >72 hours of a continuous infusion by 5 µg/kg/min every 8 to 12 hours. Patients should be monitored for potential withdrawal symptoms including anxiety, allodynia, hyperalgesia, sweating, and drowsiness.

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