Efficacy of ketamine hydrochloride sedation in children for interventional radiologic procedures

OBJECTIVE. The purpose of this study was to evaluate the efficacy of ketamine hydrochloride sedation in children younger than 11 years old who underwent short interventional radiologic procedures. SUBJECTS AND METHODS. Two hundred eleven children, 3 days to 10 years old were given Ketalar (ketamine hydrochloride: Parke-Davis. Morris Plains, NJ), either 2 mg/kg IV (114 patients) or 3 mg/kg intramuscularly (IM) (97 patients). Atropine sulfate (Fujisawa USA, Deerfield, IL) (0.01 mg/kg IV or 0.02 mg/kg IM) was added in all patients to control secretions. Patients were monitored with continuous pulse oximetry and with automatic blood pressure cuffs. Respiratory rate and heart rate were recorded every 5 min. Adequacy of sedation was graded by the radiologist. Induction time, procedure time, recovery time, and adverse effects were recorded. RESULTS. Sedation was considered excellent and the procedures were completed in 191 patients (91%). The sedation was considered light but the procedures were completed in the remaining 20 patients (9%). No sedation failures were observed. Average induction time was 45 sec for the IV procedure and 4 min for the IM procedure. Average recovery time was 18 min for the IV procedure and 25 min for the IM procedure. Average procedure time for both methods was 25 min. Hemoglobin saturation remained at or greater than 95% in 200 patients (94%). Transient desaturation below 95% occurred in 11 patients (5%). The airway was manipulated to improve ventilation (head, neck, and jaw lifts) and supplemental oxygen was given via nasal cannula or mask. The episodes lasted only a few seconds and oxygen saturation promptly returned to a level greater than 95%. A 7-week-old male infant who had been born prematurely at 32 weeks' gestation experienced apnea. Ventilation was assisted for several breaths and the patient promptly recovered. We observed only minor cardiovascular changes in all patients. CONCLUSION. Ketamine hydrochloride provides excellent sedation and analgesia in young children. The short induction time, rapid recovery, and minimal respiratory depression are features that make this sedative ideal for interventional radiology.