Intranasal ketamine for procedural sedation in children: An open-label multicenter clinical trial - 20/04/23
Abstract |
Introduction |
There are limited options for pain and distress management in children undergoing minor procedures, without the burden of an intravenous line insertion. Prior to this study, we conducted a dose-escalation study and identified 6 mg/kg as a potentially optimal initial dose of intranasal ketamine.
Objective |
To assess the efficacy and safety of intranasal ketamine at a dose of 6 mg/kg for procedural sedation to repair lacerations with sutures in children in the emergency department.
Methods |
We conducted a single-arm, open-label multicenter clinical trial for intranasal ketamine for laceration repair with sutures in children aged 1 to 12 years. A convenience sample of 30 patients received 6 mg/kg of intranasal ketamine for their procedural sedation. The primary outcome was the proportion (95% CI) of patients who achieved an effective procedural sedation.
Results |
We recruited 30 patients from April 2018 to December 2019 in two pediatric emergency departments in Canada. Lacerations repaired were mostly facial in 21(70%) patients and longer than 2 cm in 20 (67%) patients. Sedation was effective in 18/30 (60% [95% CI 45, 80]) children and was suboptimal in 5 (17%) patients but procedure was completed in them with minimal difficulties. Sedation was poor in the remaining 7 (23%) patients, with 3 (10%) of them required additional sedative agents. No serious adverse events were reported.
Conclusions |
Using a single dose of 6 mg/kg of intranasal Ketamine for laceration repair led to successful sedation in 60% of patients according to our a priori definition. An additional 17% of patients were considered suboptimal, but their procedure was still completed with minimal difficulty.
Clinical trial registration: ClinicalTrials.gov (NCT03053947).
Le texte complet de cet article est disponible en PDF.Highlights |
• | There are scarce data on intranasal ketamine for procedural sedation in children. |
• | The 6 mg/kg dose of intranasal ketamine facilitated the procedure in 60% of patients. |
• | Among parents, 89% agreed or strongly agreed that they were satisfied with the sedation. |
Keywords : Procedural sedation, Intranasal, Pain, Pediatrics
Abbreviations : ED, IV, INMAD, BRT, RSS, FLACC, FPS-R, OSBD-R, UMSS, IQR
Plan
Vol 67
P. 10-16 - mai 2023 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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