Use of ketamine sedation for the management of displaced paediatric forearm fractures

Abstract

AIMTo determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department.METHODSFollowing an agreed interdepartmental protocol, fractures of the radius and ulna (moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and post manipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also undertaken.RESULTSDuring the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate (3), fractures of both radius and ulna (6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthesia, each case performed under ketamine sedation was associated with a saving of £1470, the overall study saving being £14700.CONCLUSIONKetamine procedural sedation in the paediatric population is a safe and cost effective method for the treatment of displaced fractures of the radius and ulna, with high parent satisfaction rates.

Acceptability and feasibility of an innovative anesthesia technique in a low-resource setting at a rural community ophthalmic center: A prospective journey

“…ketamine which was used for the management of displaced pediatric forearm fractures in emergency. [ 23 ] Although this was not the primary objective of our study, the huge cuts in the financial burden on already-deprived weaker sections of the society cannot be undermined.…”

Moderate and deep sedation for non-invasive paediatric procedures in tertiary maternity and children’s hospitals in China: a questionnaire survey from China

“…Ketamine is another widely used sedation agent; it can be used safely and effectively for paediatric procedural sedation [30], especially for invasive procedures, because of its analgesic properties [31][32][33]. Recent studies have reported that ketamine can be used in combination with other sedatives for better sedation quality and fewer adverse events [34][35][36].…”

Moderate and deep sedation for non-invasive paediatric procedures in tertiary maternity and children’s hospitals in China: A questionnaire survey from China

“…Ketamine is another widely used sedation agent; it can be used safely and effectively for paediatric procedural sedation 30 , especially for invasive procedures, because of its analgesic properties [31][32][33] .…”