Table 1: Indications [1]  (Click to enlarge)

Table 1 shows the list of indications from the landmark paper describing IM ketamine sedation for 1022 children in the ED [1]:

Two important points to consider before you opt for ketamine sedation:

  1. Ensure that your child has received appropriate analgesia. This might include intranasal diamorphine, paracetamol, ibuprofen or all three as appropriate
  2. Have you properly considered alternative strategies to sedation or anxiolysis, e.g. Entonox or even more concentrated nitrous oxide/oxygen mixtures?
  • Do you have some experience in distraction techniques?

    • Get the help of an experienced nurse and encourage parental co-operation
    • Some well-described examples include: music [4], hypnosis [5], confusing tactile stimuli [6] and blowing away pain [7]
    • A current tactic is to use a DVD, selecting suitable material for each age group     (know your Upsy Daisy  from your Shrek !)
    • Information regarding the entire procedure can also be related to the smaller child in the form of a story [8]
  • Is there a role for topical local anaesthetic agents for wound toilet, and steristrips or glue for wound closure? You might diminish the pain on infiltration of (warmed) local anaesthetics by injecting slowly and using a fine gauge needle
  • Are you familiar with the pearls of foreign body removal that may obviate the need for sedation (the ‘magic kiss’ for example)?
  • Is the laceration too complex for a brief (< 20 minute) repair?
  • Might the orthopaedic procedure be better performed with image intensifier support in theatre?

Ensure that your child has received appropriate analgesia before considering sedation.

Carefully consider alternative strategies to sedation in general.