Postprocedure

The College advice is:

• The child should recover in a quiet, observed and monitored area under the continuous observation of a trained member of staff. Recovery should be complete between 60 and 120 minutes, depending on the dose and route used.
• The child can be safely discharged once they are able to ambulate and vocalise/converse at pre-sedation levels. An advice sheet should be given to the parent or guardian advising rest, quiet and supervised activity for the remainder of that day. The child should not eat or drink for two hours after discharge because of the risk of nausea and vomiting.

Click here for an example Ketamine Information Sheet for Parents (Appendix 3).

So is 1:1 nursing in an area replete with paediatric resuscitations facilities required until discharge? Or more simply put, when can the child leave resus?

A useful analysis of the timing of adverse events in ED sedation exists: 353 of the 1,367 children in the study received ketamine. [10]

Three pertinent findings were:

•  Only 8% of adverse events occurred after the procedure
•  Median time to serious adverse event was 2 mins after the last sedative dose
•  No primary adverse event after 25 mins

My own department’s policy is to move the child to a dedicated paediatric observation area with oxygen saturation monitoring only, as soon as the child shows signs of recovery, i.e. starts talking to mum or dad. This ‘admit for observation’ strategy also obviates any concern regarding the 4 hour target.

Learning bite

A primary adverse event arising later than 30 minutes following the last ketamine dose is exceptional.