What is the nature of the emergence phenomenon when using intravenous or intramuscular ketamine for paediatric procedural sedation?

Treston, Greg; Bell, Anthony; Cardwell, Robert; Fincher, Gavin; Chand, Dip; Cashion, Geoff

doi:10.1111/j.1742-6723.2009.01203.x

Cited by 30 publications

(17 citation statements)

References 38 publications

(142 reference statements)

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“…These results coincided with a randomized clinical trial by Eghbal et al, which determined low dose ketamine during induction of anesthesia improved both emergence agitation and postoperative pain following adenotonsillectomy in children [79]. Similarly, Abu-Shahwan and Chowdary's randomized double blind study of 85 children aged 4-7 years demonstrated that treatment with ketamine 0.25 mg/kg decreased the incidence of emergence agitation [77].…”

Section: Ketaminesupporting

confidence: 76%

“…Debate about the efficacy of ketamine in the management of ED is largely driven by earlier studies that linked ketamine to an increased risk of ED [1,[73][74][75]. However, more recent studies have contradicted these findings [76][77][78][79]. In a study where 80 pediatric patients were given oral ketamine 6 mg/kg, 18% developed ED, much lower than the 56% reported in the placebo group [76].…”

Section: Ketaminementioning

confidence: 99%

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Emergence delirium: a narrative review

Viswanath¹,

Kerner²,

Jean³

et al. 2015

J Anesthesiol Clin Sci

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Emergence delirium (ED) is a post-surgical phenomenon associated with an increase in morbidity, mortality and resource utilization. A systematic review of all current treatment modalities for this condition is imperative given its prevalence during postoperative recovery. This review scrutinizes a number of studies in order to better characterize ED, with particular focus paid to the condition's etiology, associated risk factors, prevention and management. Extensive studies have been conducted on the pediatric population with little attention directed towards the adult and geriatric age groups. Despite this, evidence-based protocols for the management of this condition are still lacking for all age groups. In order to ensure cost effective management and improved safety outcomes for ED, future research should establish and further improve upon screening protocols to identify at risk patients, in addition to formulating a standardized treatment regimen for perioperative patients at risk. Keywords: Emergence delirium, anesthesia recovery period, anesthetic issues and peri-operative care, perioperative complications, preoperative evaluation and anesthesia risk, complications in the post anesthesia care unit

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Section: Ketaminesupporting

confidence: 76%

Section: Ketaminementioning

confidence: 99%

Emergence delirium: a narrative review

Viswanath¹,

Kerner²,

Jean³

et al. 2015

J Anesthesiol Clin Sci

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“…Information shall include objectives of the sedation and anticipated changes in behavior during and after sedation. 163,[253][254][255] Special instructions shall be given to the adult responsible for infants and toddlers who will be transported home in a car safety seat regarding the need to carefully observe the child's head position to avoid airway obstruction. Transportation in a car safety seat poses a particular risk for infants who have received medications known to have a long half-life, such as chloral hydrate, intramuscular pentobarbital, or phenothiazine because deaths after procedural sedation have been reported.…”

Section: On-site Monitoring Rescue Drugs and Equipmentmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

Coté¹,

Wilson²

2016

Pediatrics

252

199

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age-and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, suffi cient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the presedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions. This report was developed through a collaborative effort of the

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“…Innovative research and critical appraisal of the literature by Australian EPs provide a local context for PSA. [10][11][12][13][14][15][16][17][18][19][20][21][22] Credentialing processes and competency-based assessments are becoming more widespread 23,24 and some Australian states have linked incentive funding to the establishment of PSA credentialing. Such processes educate staff about patient risk assessment, monitoring requirements, potential complications and the skill mix required for delivering PSA.…”

Section: Introductionmentioning

confidence: 99%