Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

• Published in: Pediatric critical care medicine Vol. 18; no. 8; p. e356
• Main Authors: Grunwell, Jocelyn R, Travers, Curtis, Stormorken, Anne G, Scherrer, Patricia D, Chumpitazi, Corrie E, Stockwell, Jana A, Roback, Mark G, Cravero, Joseph, Kamat, Pradip P
• Format: Journal Article
• Language: English
• Published: United States 01.08.2017
• Subjects: Adolescent; Anesthetics, Dissociative - administration & dosage; Anesthetics, Dissociative - adverse effects; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - adverse effects; Child; Child, Preschool; Databases, Factual; Female; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Infant; Infant, Newborn; Ketamine - administration & dosage; Ketamine - adverse effects; Male; Odds Ratio; Propofol - administration & dosage; Propofol - adverse effects; Retrospective Studies; Young Adult
• ISSN: 1529-7535
• DOI: 10.1097/PCC.0000000000001246

Outcomes associated with a sedative regimen comprised ketamine + propofol for pediatric procedural sedation outside of both the pediatric emergency department and operating room are underreported. We used the Pediatric Sedation Research Consortium database to describe a multicenter experience with ketamine + propofol by pediatric sedation providers. Prospective observational study of children receiving IV ketamine + propofol for procedural sedation outside of the operating room and emergency department using data abstracted from the Pediatric Sedation Research Consortium during 2007-2015. Procedural sedation services from academic, community, free-standing children's hospitals, and pediatric wards within general hospitals. Children from birth to less than or equal to 21 years old. None. A total of 7,313 pediatric procedural sedations were performed using IV ketamine + propofol as the primary sedative regimen. Median age was 84 months (range, < 1 mo to ≤ 21 yr; interquartile range, 36-144); 80.6% were American Society of Anesthesiologists-Physical Status less than III. The majority of sedation was performed in dedicated sedation or radiology units (76.1%). Procedures were successfully completed in 99.8% of patients. Anticholinergics (glycopyrrolate and atropine) or benzodiazepines (midazolam and lorazepam) were used in 14.2% and 41.3%, respectively. The overall adverse event and serious adverse event rates were 9.79% (95% CI, 9.12-10.49%) and 3.47% (95% CI, 3.07-3.92%), respectively. No deaths occurred. Risk factors associated with an increase in odds of adverse event included ASA status greater than or equal to III, dental suite, cardiac catheterization laboratory or radiology/sedation suite location, a primary diagnosis of having a gastrointestinal illness, and the coadministration of an anticholinergic. Using Pediatric Sedation Research Consortium data, we describe the diverse use of IV ketamine + propofol for procedural sedation in the largest reported cohort of children to date. Data from this study may be used to design sufficiently powered prospective randomized, double-blind studies comparing outcomes of sedation between commonly administered sedative and analgesic medication regimens.