• Soha Rached-d'Astous, Yaron Finkelstein, Benoit Bailey, Christopher Marquis, Denis Lebel, Marie-Pier Desjardins, and Evelyne D Trottier.
• Pediatric Emergency Department, Centre Hospitalier Universitaire Sainte Justine, Université de Montréal, 3175 Chem. de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada. Electronic address: soha.rached-dastous.med@ssss.gouv.qc.ca.
• Am J Emerg Med. 2023 May 1; 67: 101610-16.

IntroductionThere 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.ObjectiveTo 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.MethodsWe 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.ResultsWe 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.ConclusionsUsing 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 RegistrationClinicalTrials.gov (NCT03053947).Copyright © 2023. Published by Elsevier Inc.

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