Ketamine Versus Co-administration of Ketamine and Propofol for Procedural Sedation in a Pediatric Emergency Department
| Status: | Completed |
|---|---|
| Conditions: | Hospital |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 3 - 21 |
| Updated: | 12/10/2017 |
| Start Date: | January 2011 |
| End Date: | November 3, 2017 |
Comparison of Ketamine Versus Co-Administration of Ketamine and Propofol for Procedural Sedation in a Pediatric Emergency Department
The purpose of this study is to compare the effectiveness of the co-administration of
intravenous ketamine and propofol to intravenous ketamine as a single agent for procedural
sedation in the pediatric emergency department. The investigators hypothesize that patients
receiving co-administration of ketamine and propofol will have a lower rate of adverse
events, compared to patients receiving ketamine for procedural sedation.
intravenous ketamine and propofol to intravenous ketamine as a single agent for procedural
sedation in the pediatric emergency department. The investigators hypothesize that patients
receiving co-administration of ketamine and propofol will have a lower rate of adverse
events, compared to patients receiving ketamine for procedural sedation.
Procedural sedation and analgesia (PSA) is a frequent occurrence in pediatric emergency
departments. The goals of PSA include maximizing analgesia and amnesia, and minimizing
adverse events while ensuring stable cardiopulmonary function. For decades, ketamine has been
the main pharmacologic agent used for pediatric PSA. Numerous studies support the use of
ketamine for sedation, amnesia, and analgesia on children undergoing painful procedures in
the emergency department setting. Research has continually shown ketamine to cause emergence
phenomenon, laryngospasm and vomiting.
Propofol is a sedative-hypnotic widely used for procedural sedation in adult emergency
departments. The advantages of propofol include rapid onset, with quick and predictable
recovery time, and antiemetic effects. Disadvantages include dose-dependent hypotension,
bradycardia, respiratory depression, as well as pain with injection. In addition, propofol
does not provide any analgesia.
Ketamine and propofol administered together have been successfully utilized in a variety of
settings, including dermatologic, cardiovascular, and interventional radiological procedures
in children. The co-administration of ketamine and propofol has been shown to preserve
sedation while minimizing the respective adverse events. When used in combination, doses
administered of each can be reduced, while producing a more stable hemodynamic and
respiratory profile. Furthermore, this combination may reduce the frequency of emergence
reactions, vomiting, and the pain of propofol injection.
To date, there are no randomized controlled trials evaluating the co-administration of
ketamine and propofol versus ketamine monotherapy for PSA in the Pediatric Emergency
Department.
departments. The goals of PSA include maximizing analgesia and amnesia, and minimizing
adverse events while ensuring stable cardiopulmonary function. For decades, ketamine has been
the main pharmacologic agent used for pediatric PSA. Numerous studies support the use of
ketamine for sedation, amnesia, and analgesia on children undergoing painful procedures in
the emergency department setting. Research has continually shown ketamine to cause emergence
phenomenon, laryngospasm and vomiting.
Propofol is a sedative-hypnotic widely used for procedural sedation in adult emergency
departments. The advantages of propofol include rapid onset, with quick and predictable
recovery time, and antiemetic effects. Disadvantages include dose-dependent hypotension,
bradycardia, respiratory depression, as well as pain with injection. In addition, propofol
does not provide any analgesia.
Ketamine and propofol administered together have been successfully utilized in a variety of
settings, including dermatologic, cardiovascular, and interventional radiological procedures
in children. The co-administration of ketamine and propofol has been shown to preserve
sedation while minimizing the respective adverse events. When used in combination, doses
administered of each can be reduced, while producing a more stable hemodynamic and
respiratory profile. Furthermore, this combination may reduce the frequency of emergence
reactions, vomiting, and the pain of propofol injection.
To date, there are no randomized controlled trials evaluating the co-administration of
ketamine and propofol versus ketamine monotherapy for PSA in the Pediatric Emergency
Department.
Inclusion Criteria:
- Ages > 3 years and < 21 years
- American Society of Anesthesiologists (ASA) class I or II
- Fracture or dislocation requiring reduction under procedural sedation with ketamine as
deemed by the attending emergency medicine physician
- Parent/Legal Guardian or Patient (if 18 years of age or older) has already given
verbal consent for procedural sedation as part of standard care for their condition
Exclusion Criteria:
- Hypertension (Blood Pressure > 95th percentile for age)
- Glaucoma or acute globe injury
- Increased intracranial pressure or central nervous system mass lesion
- Porphyria
- Previous allergic reaction to ketamine
- Previous allergic reaction to Propofol or its components including soybean oil,
glycerol, egg lecithin, and disodium edentate
- Disorders of lipid metabolism including primary hyperlipoproteinemia, diabetic
hyperlipemia, or pancreatitis
- Mitochondrial myopathies or disorders of electron transport
- Pregnancy
- Parent, guardian or patient unwilling/unable to provide informed consent/assent
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