Roback MG, Wathen JE, MacKenzie T, Bajaj L. A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures. Ann Emerg Med. 2006 Nov.;48(5):605–612. PMID 17052563
This is (apparently) the first prospective IV v IM trial of ketamine for sedation. I have never given it IM, though it was previously on the CEM guideline as IM 4mg/kg. They now recommend 1mg/kg IV or 2.5mg/kg IM.
Anyhow to the trial.
- paeds childrens ED
- sedation for fracture reduction
- randomised but unblinded
- 1mg/kg IV v 4mg/kg IM
- everyone got glycopyrolate
- tried to blind but gave up when it didn’t work
- n = 208
- missed a whole bunch of eligible pts and not clear why
- 100 each group
- everyone did great
- there were a couple of minor desaturations in the IV group
- 35% vomiting IM; 18% vomiting IV
- IM had a much longer period of sedation 130 mins v 80 mins
- had to stop the study at nursing request cause they could tell which was which because of the performance characteristics
There was a much higher rate of vomiting than most studies. It’s usually reported about 5-10%. Their numbers seem pretty high.
As always it’s good to see that this is a remarkably safe thing for us to do in the ED.
I imagine a 35% vomiting rate wouldn’t be the most acceptable if you were an a gas man/woman working in an OT setting but in the ED we’re trying to balance all kinds of spinning plates and safety and ease are pretty important factors.
I think I’ll stick to giving IV ketamine for now.