Pediatric EM Interest Group
For anyone who works with pediatric patients in the ED setting.
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Intranasal Ketamine
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Intranasal Ketamine
Hi everyone! We recently had some interest in our pediatric ED in using intranasal ketamine for procedural sedation. Our MDs are not super familiar with it leading to some hesitancies, and I was wondering if any of you have had good experiences? Who do you find is an ideal patient for this? Also, what dosing do you find works best?
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3 Replies
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Hi Tessa! We only have used it here for analgesia/sub-dissociative dosing and have found it mainly useful in that scenario vs. procedural sedation. One of our doctors told me that they have had to use upwards of 8 mg/kg historically to try to do procedural sedation and it still didn’t sedate the patient well, so they don’t enjoy doing it. We normally resort to IM ketamine for our very few difficult patients here if we can’t get an IV (shout out to Child Life, our CLS is dare I say better than all the ketamine in the world). Super excited to hear more people’s experiences!
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We also only do IM rather than IN ketamine for procedural sedation, but it’s rare that we can’t get an IV.
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Hi Tessa! My colleague and I recently presented on this topic and I would be glad to share those materials as well as our compiled articles with you. My current institution doesn’t use IN ketamine at this time. We found literature showing doses of up to 9 mg/kg, max of 200mg. Biggest issue that came up in the literature was increased N/V compared to other IN agents.
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