Ketamine
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Ketamine
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hypoventilation associated with ketamine. The WHO Adverse Drug Reactions database contained three reports of hypoventilation associated with ketamine.
Hypoventilation (first report), hypoxia, tachycardia and vomiting in paediatric patients: 25 case reports In a retrospective study evaluating the association between ketamine-induced adverse events and prior oral analgesic use in patients aged < 18 years, 25 patients were identified who developed adverse reactions following ketamine administration [duration of treatments to reaction onsets not stated]. Patient details are summarised in tables 1 and 2. All patients had been hospitalised for closed reduction of upper or lower extremity fractures, and had received ketamine for procedural sedation and analgesia. The reported adverse reactions were vomiting (patients 1–17), hypoxia (patients 18–20, 23–25), tachycardia (patient 21) and hypoventilation (patient 22). Patients 7–17 and 25 had received oral analgesics (paracetamol [acetaminophen]/ codeine or ibuprofen) before ketamine administration. IV analgesia had been administered to 16 patients after (patients 20 and 22) or before they received ketamine. [Treatments and patient outcomes not stated.] Author comment: "This study supports the hypothesis that recent oral analgesia does not impact the incidence of adverse events in patients undergoing ketamine procedural sedation and analgesia."
Table 1 Patient/sex/ age (years)
Oral analgesia; IV analgesia
1/M/12.1 2/F/6.8 3/M/13.9 4/M/13.9 5/M/12.8 6/M/14.7 7/M/12.1 8/M/9.9 9/M/11.7 10/M/14.1 11/M/8.2 12/F/10.9
none; none none; none none; morphine none; morphine none; none none; morphine paracetamol/codeine; none paracetamol/codeine; morphine paracetamol/codeine; morphine paracetamol/codeine; morphine paracetamol/codeine; morphine ibuprofen; none
Ketamine dose (mg/kg) 1.72 1.09 0.98 1.00 0.72 1.47 1.00 1.55 1.08 0.85 2.10 1.04
Table 2 Patient/sex/ age (years)
Oral analgesia; IV analgesia
13/M/13.2 14/M/7.9 15/M/13.4 16/M/12.8 17/M/13.2 18/M/1.7 19/M/17.2 20/M/6.9 21/M/8.5 22/M/4.8 23/M/9.7 24/F/10.5 25/M/14.4
paracetamol/codeine; morphine Paracetamol/codeine; none paracetamol/codeine; morphine paracetamol/codeine; morphine paracetamol/codeine; fentanyl none; none none; morphine none; morphine none; none none; morphine, midazolam none; none none; none paracetamol/codeine; morphine
Ketamine dose (mg/kg) 1.00 2.47 1.03 1.01 1.12 4.00 2.75 1.39 1.24 1.60 2.91 1.52 1.06
McKee MR, et al. Oral analgesia before pediatric ketamine sedation is not associated with an increased risk of emesis and other adverse events. Journal of 801117373 Emergency Medicine 35: 23-28, No. 1, Jul 2008 - USA
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of 0114-9954/10/1216-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 23 Aug 2008 No. 1216
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