Can a Lower Pediatric Dose of Ketamine Be Used if Infused More Rapidly?

As a procedural sedation agent, ketamine is given to children at a dose of 1.0 to 1.5 mg/kg and is recommended to be infused over 30 to 60 seconds. Investigators hypothesized that a more rapid infusion, over only 5 seconds, might allow lower dosing.

In a single-center pilot study, 60 healthy children aged 2 to 17 years with forearm fractures were given various doses of ketamine prior to fracture reduction. Most participants (93%) received opioid premedication. Overall, 95% of children were effectively sedated with a dose of 0.7 to 0.8 mg/kg. However, the investigators monitored the effectiveness of sedation only during the initial 5 minutes of reduction attempts. Adverse events were mild and mostly limited to vomiting.