Rapid Administration Technique of Ketamine for Pediatric Forearm Fracture Reduction: A Dose-Finding Study - 24/05/15
Abstract |
Study objective |
We estimate the minimum dose and total sedation time of rapidly infused ketamine that achieves 3 to 5 minutes of effective sedation in children undergoing forearm fracture reduction in the emergency department.
Methods |
We used the up-down method to estimate the median dose of intravenous ketamine infused during less than or equal to 5 seconds that provided effective sedation in 50% (ED50) and 95% (ED95) of healthy children aged 2 to 5, 6 to 11, or 12 to 17 years who were undergoing forearm fracture reduction. Most patients were pretreated with opioids. Three investigators blinded to ketamine dose independently graded sedation effectiveness by viewing a video recording of the first 5 minutes of sedation. Recovery was assessed by modified Aldrete score.
Results |
We enrolled 20 children in each age group. The estimated ED50 was 0.7, 0.5, and 0.6 mg/kg and the estimated ED95 was 0.7, 0.7, and 0.8 mg/kg for the groups aged 2 to 5, 6 to 11, and 12 to 17 years, respectively. For the group aged 2 to 5 years, an empirically derived ED95 was 0.8 mg/kg. All patients who received the empirically derived ED95 in the group aged 2 to 5 years or the estimated ED95 in the groups aged 6 to 11 and 12 to 17 years had effective sedation. The median total sedation time for the 3 age groups, respectively, was 25, 22.5, and 25 minutes if 1 dose of ketamine was administered and 35, 25, and 45 minutes if additional doses were administered. No participant experienced serious adverse events.
Conclusion |
We estimated ED50 and ED95 for rapidly infused ketamine for 3 age groups undergoing fracture reduction. Total sedation time was shorter than that in most previous studies.
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Please see page 641 for the Editor’s Capsule Summary of this article. |
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Supervising editor: Steven M. Green, MD |
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Author contributions: All authors were involved in conceiving and designing the study, in data analysis, in article preparation, and in final article revisions. SSC, DMJ, and RMK obtained funding for the study. SSC enrolled the patients and collected data. SSC takes responsibility for the paper as a whole. |
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Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: Partial salary support for Dr. Chinta and partial funding for the study were provided by a National Institutes of Health T32 grant (T32HD049338-01A2), a Clinical and Translational Science Award (UL1TR000448), and a Ken Graff Young Investigator award from American Academy of Pediatrics–Section on Emergency Medicine. |
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Vol 65 - N° 6
P. 640 - juin 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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