KETAMINE SEDATION FOR PEDIATRIC GASTROINTESTINAL PROCEDURES

Abstract

Objective: To study the safety and efficacy of Ketamine for pediatric gastrointestinal procedures.
Study Design: Quasi-experimental study
Place and Duration of Study: Military hospital Rawalpindi over a period of 11 years from January 1999 to December 2009.
Patients and Methods: The study was conducted in a series of children receiving ketamine administered by pediatric gastroenterologists skilled in basic airway management to facilitate pediatric gastrointestinal procedures. Patient's data was recorded for each sedation to determine age, gender, indication, effectiveness of the sedation and adverse effects. Initial dose of Ketamine 1.0 mg/kg was administered. A second dose of Ketamine1.0 mg/kg was given after 2 to 3 minutes if adequate sedation had not been achieved. Subsequent doses of 0.5 to 1.0 mg/kg Ketamine were given as necessary and adverse events associated with the sedative regimen were documented.
Results: Ketamine was administered to 954 patients who underwent G.I. endoscopies, ranging in age from 2 months to 17 years with mean age of 6.6 years (SD±3.5). Six (0.6%) patients experienced a significant drop in O2 saturation (<85%) that required interruption of the procedure and/or mild stimulation/ oxygen supplementation. Increased oral secretions, requiring repeated oral suction was noted in most patients undergoing these procedures. Inadequate sedation was noted in just ten patients (1%). Two patient (0.2%) developed laryngospasm. Vomiting at recovery from sedation was noted in 35 (3.7%) patients. Myoclonic jerks and involuntary movements were noted in 5 (0.5%) patients. No episode of aspiration was observed. No patient required intubation or bag/mask ventilation.
Conclusion: Pediatric gastroenterologists skilled in ketamine administration and basic airway management can effectively administer this drug to facilitate gastrointestinal procedures.