Analysis of adverse outcomes in pediatric patients receiving sub-anesthetic ketamine infusions in non-intensive care units
Masaracchia MM1 , Lee JY2 , Fernandez PG1
1. University of Colorado Department of Anesthesiology, Children’s Hospital Colorado, Section of Pediatric Anesthesiology
2. University of Colorado School of Medicine
Sub-anesthetic ketamine infusions are often employed in pain management. High doses of ketamine can be associated with adverse effects including: nervous system excitation, sedation, hypertension, tachycardia. Sub-hypnotic infusions (≤0.3mg/kg/hr) are less likely to have these adverse effects. Many institutions restrict low-dose ketamine infusions to intensive care units. We have been administering low dose infusions in unmonitored pediatric units for several years. We assessed adverse outcomes for this patient group over our 5 year experience.
Retrospective analysis of patients ages 0-21 years receiving low dose ketamine outside of ICU. Events captured: sedation, neurological excitation, hemodynamic changes, RRT triggers, escalations in level of care. Pain Outcomes: acute vs. chronic pain, maximum infusion rate, infusion duration, average daily morphine equivalents and pain scores pre- and post-ketamine infusion.
Minimal side effect profile for patients receiving low dose ketamine infusions. No attributable escalation in care or adverse events in pediatric patients.
Post-ketamine infusion, there was an overall reduction in highest VAS score for all patients. Patients undergoing infusion for chronic pain exacerbation only saw a statistically significant decrease in opioid consumption.
Increased low dose ketamine infusion utilization on the wards for pain management. Increased patient access to ketamine infusions without escalation of care, thus reducing cost.
Sheehy KA, et al. Subanesthetic ketamine for pain management in hospitalized children, adolescents, and young adults: a single-center cohort study. J Pain Res. 2017. 10: 787-795.