Pain experienced by children undergoing `routine` procedures continues to be undertreated. Ketamine has been used intravenously and intramuscularly for years in the pediatric emergency department to achieve moderate to deep sedation. In recent years, it has also been used in subdissociative dosing in order to treat pain. We theorized that low-dose intranasal ketamine would effectively treat pain and anxiety in children experiencing minor painful procedures.
We performed a feasibility study using 1 mg/kg intranasal ketamine before venipuncture or IV placement in children aged 1-12 years who showed resistance to the procedure. We asked nursing staff, parents and children old enough to reliably rate report pain to rate the experience using a combined FACES/VAS scale and to report whether they would choose this method for future procedures.
16 children have been recruited, with an average age of seven years. Most children (12/16) were reported to have a Michigan Sedation Score of 1. Procedures were completed in one attempt in all but two children. Average VAS per nursing parent and per child was 3.5 and was similar with all reporters. All but three children returned to baseline behavior per parents within a half hour of receiving the medication. Responses were positive, with 5/8 children, 7/12 nurses and 15/16 parents reporting that they would choose this method for future procedures. Adverse events were limited to nausea reported in one child and vomiting in one child who was vomiting on arrival to the emergency department. No child had any serious adverse events.
