Keira Park Mason MD, Presenter: Nothing to Disclose

Horacio Munsayac Padua MD, Abstract Co-Author: Nothing to Disclose

Paulette Fontaine BS, Abstract Co-Author: Nothing to Disclose

David Zurakowski PhD, Abstract Co-Author: Nothing to Disclose

Interventional Radiologists are often challenged with sedation and analgesia options for pediatric procedures, and request general anesthesia to ensure safe conditions. Radiologist-supervised ketamine sedation offers an effective alternative to anesthesia.  

After IRB approval, quality assurance data which documents patient demographics, outcome parameters and adverse events were reviewed. All patients/parents signed informed consent to receive ketamine for sedation in interventional radiology (IR). Ketamine is ordered by the interventional radiologist and administered by the radiology nurse per protocol: premedication with .005mg/kg intravenous (IV) glycopyrrolate as an antisialagogue followed by a bolus of 2 mg/kg IV ketamine and a subsequent ketamine continuous infusion IV of up to 125 mcg/kg/min, titrated to the responsiveness of the patient.

Between 2001-2007, 580 children received ketamine for 611 procedures which included peripheral intravenous central catheters (n=358), chest tubes (n=54), biopsies (n=89), drainage tube (n=50). Mean age was 5.7 years (range 0.3-18 years). The mean for American Society of Anesthesiologists (ASA) score was ASA 2 (range 1-4). 57% and 31% of children were ASA 2 and 3 respectively. Duration of ketamine sedation averaged 50.4 min (range 5-173), with average procedure time of 42.6 min (range 5-155) and mean recovery time 56.1 min (range 0-325).  There were no critical adverse events, cardiopulmonary resuscitation nor need for endotracheal intubation. 11 children had brief oxygen desaturations and 4 required brief positive pressure mask ventilation. All procedures were successfully completed.

Interventional procedures in the pediatric population can be challenging, often necessitating general anesthesia to ensure immobility, adequate analgesia and safe conditions. In appropriate instances, an interventional radiologist can supervise a nursing-administered ketamine protocol to provide safe, effective analgesia and sedation with relatively short recovery time.

An interventional radiologist can supervise a nursing-administered ketamine protocol to provide children wtih safe, effective analgesia and sedation with a relatively short recovery time.

Mason, K, Padua, H, Fontaine, P, Zurakowski, D, Radiologist -supervised Ketamine Sedation for Pediatric Interventional Procedures.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6007240.html