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Titolo:
Ketamine sedation for pediatric gastroenterology procedures
Autore:
Green, SM; Klooster, M; Harris, T; Lynch, EL; Rothrock, SG;
Indirizzi:
Loma Linda Univ, Med Ctr, Dept Emergency Med, Loma Linda, CA 92354 USA Loma Linda Univ Loma Linda CA USA 92354 ncy Med, Loma Linda, CA 92354 USA Loma Linda Univ, Med Ctr, Dept Pediat, Loma Linda, CA USA Loma Linda UnivLoma Linda CA USA d Ctr, Dept Pediat, Loma Linda, CA USA Childrens Hosp, Loma Linda, CA USA Childrens Hosp Loma Linda CA USAChildrens Hosp, Loma Linda, CA USA Orlando Reg Med Ctr, Dept Emergency Med, Orlando, FL USA Orlando Reg Med Ctr Orlando FL USA , Dept Emergency Med, Orlando, FL USA
Titolo Testata:
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
fascicolo: 1, volume: 32, anno: 2001,
pagine: 26 - 33
SICI:
0277-2116(200101)32:1<26:KSFPGP>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
UPPER GASTROINTESTINAL ENDOSCOPY; INTRAMUSCULAR KETAMINE; INTRAVENOUS SEDATION; GENERAL-ANESTHESIA; ONCOLOGY PATIENTS; SAFETY PROFILE; MIDAZOLAM; EMERGENCY; CHILDREN; MEPERIDINE;
Keywords:
child; dissociative sedation; endoscopy; gastroenterology; ketamine;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
47
Recensione:
Indirizzi per estratti:
Indirizzo: Green, SM Loma Linda Univ, Med Ctr, Dept Emergency Med, Loma Linda, CA 92354 USA Loma Linda Univ Loma Linda CA USA 92354 oma Linda, CA 92354 USA
Citazione:
S.M. Green et al., "Ketamine sedation for pediatric gastroenterology procedures", J PED GASTR, 32(1), 2001, pp. 26-33

Abstract

Background: Although the dissociative sedative ketamine is used commonly for pediatric procedural sedation in other settings, the safety of this agent in pediatric gastroenterology is not well-studied. A 5-year experience with ketamine sedation for pediatric gastroenterology procedures was reviewedto document the safety profile of this agent and to identify predictors oflaryngospasm during esophagogastroduodenoscopy (EGD). Methods: The study was a retrospective consecutive case series of childrenreceiving ketamine administered by pediatric gastroenterologists skilled in basic airway management to facilitate pediatric gastrointestinal procedures during a 5-year period. Patient's records were reviewed to determine indication, dosage, adverse effects, drugs, inadequate sedation, and recovery time for each sedation. A multiple logistic regression analysis was performed to identify predictors of laryngospasm during EGD. Outcome measures weredescriptive features of sedation, including adverse effects and predictorsof laryngospasm during EGD. Results: During the study period pediatric gastroenterologists administered ketamine 636 times, primarily for EGD (86%) and primarily by the intravenous route (98%). The median loading dose and total dose were 1.00 mg/kg and1.34 mg/kg, respectively. Inadequate sedation was noted in seven (1.1%) procedures. Adverse effects included transient laryngospasm (8.2%), emesis (4.1%), recovery agitation (2.4%), partial airway obstruction (1.3#), apnea and respiratory depression (0.5%), and excessive salivation (0.3%). There were no adverse outcomes attributable to ketamine. Nearly half (46%) the subjects had severe underlying illness (American Society of Anesthesiologists [ASA] class greater than or equal to3). All instances of laryngospasm occurred during EGD (9.5% incidence), and the only independent predictor of laryngospasm in this sample was decreasing age. The incidence of laryngospasm was 13.9% in preschool-aged (less than or equal to6 years) children and was 3.6% in school-aged (>6 years) children (difference 10.3%, 95% confidence intervals 5.5-14.9%). No dose relationship was noted with laryngospasm, and the risk did not increase with underlying illness. Conclusion: Pediatric gastroenterologists skilled in ketamine administration and basic airway management can effectively administer this drug to facilitate gastrointestinal procedures. Transient laryngospasm occurred in 9.5%of children receiving ketamine for EGD, and its incidence was greater in preschool than in school-aged children.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/03/20 alle ore 19:49:51