Recovery / discharge

Your patient’s vital signs should be monitored until they are no longer at risk for hypoxaemia. The largest study to date8 in which the timing of adverse outcomes can be examined included 353 children receiving ketamine and 672 receiving midazolam and fentanyl. Only 8% of the adverse events occurred after the procedure. In addition the median time to serious adverse effects was two and a half minutes following the last intravenous medication. No primary adverse event occurred after 25 minutes from the last intravenous medication.

Guidance regarding discharge is given in Table 9

Table 9: Guidelines for discharge

1. Vital signs should be stable and within acceptable limits.

2. Sufficient time (up to 2 hours) should have elapsed after the last administration of reversal agents (naloxone, flumazenil) to ensure that patients do not become re-sedated after reversal effects have worn off.

3. Patients should be discharged in the presence of a responsible adult who will accompany them home and be able to report any post procedural complications.

4. Patients and their escorts should be provided with written instructions regarding post procedural diet, medications, driving, other activities such as operating machinery and signing legal documents, and a phone number to be called in case of emergency.