• Steven M Green, Mark G Roback, Baruch Krauss, Lance Brown, Ray G McGlone, Dewesh Agrawal, Michele McKee, Markus Weiss, Raymond D Pitetti, Mark A Hostetler, Joe E Wathen, Greg Treston, Barbara M Garcia Pena, Andreas C Gerber, Joseph D Losek, and Emergency Department Ketamine Meta-Analysis Study Group.
• Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA. steve@viridissimo.com
• Ann Emerg Med. 2009 Aug 1;54(2):158-68.e1-4.

Study ObjectiveAlthough ketamine is one of the most commonly used sedatives to facilitate painful procedures for children in the emergency department (ED), existing studies have not been large enough to identify clinical factors that are predictive of uncommon airway and respiratory adverse events.MethodsWe pooled individual-patient data from 32 ED studies and performed multiple logistic regressions to determine which clinical variables would predict airway and respiratory adverse events.ResultsIn 8,282 pediatric ketamine sedations, the overall incidence of airway and respiratory adverse events was 3.9%, with the following significant independent predictors: younger than 2 years (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.47 to 2.72), aged 13 years or older (OR 2.72; 95% CI 1.97 to 3.75), high intravenous dosing (initial dose > or =2.5 mg/kg or total dose > or =5.0 mg/kg; OR 2.18; 95% CI 1.59 to 2.99), coadministered anticholinergic (OR 1.82; 95% CI 1.36 to 2.42), and coadministered benzodiazepine (OR 1.39; 95% CI 1.08 to 1.78). Variables without independent association included oropharyngeal procedures, underlying physical illness (American Society of Anesthesiologists class >or = 3), and the choice of intravenous versus intramuscular route.ConclusionRisk factors that predict ketamine-associated airway and respiratory adverse events are high intravenous doses, administration to children younger than 2 years or aged 13 years or older, and the use of coadministered anticholinergics or benzodiazepines.

29 keywords...

hide…