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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-24282

Green, S M; Roback, M G; Krauss, B; Brown, L; McGlone, R G; Agrawal, D; McKee, M; Weiss, M; Pitetti, R D; Hostetler, M A; Wathen, J E; Treston, G; Garcia Pena, B M; Gerber, A C; Losek, J D (2009). Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children. Annals of Emergency Medicine, 54(2):158-168.e1.

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Abstract

STUDY OBJECTIVE: Although ketamine is one of the most commonly used sedatives to facilitate painful procedures for children in the emergency department (ED), existing studies have not been large enough to identify clinical factors that are predictive of uncommon airway and respiratory adverse events. METHODS: We pooled individual-patient data from 32 ED studies and performed multiple logistic regressions to determine which clinical variables would predict airway and respiratory adverse events. RESULTS: In 8,282 pediatric ketamine sedations, the overall incidence of airway and respiratory adverse events was 3.9%, with the following significant independent predictors: younger than 2 years (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.47 to 2.72), aged 13 years or older (OR 2.72; 95% CI 1.97 to 3.75), high intravenous dosing (initial dose > or =2.5 mg/kg or total dose > or =5.0 mg/kg; OR 2.18; 95% CI 1.59 to 2.99), coadministered anticholinergic (OR 1.82; 95% CI 1.36 to 2.42), and coadministered benzodiazepine (OR 1.39; 95% CI 1.08 to 1.78). Variables without independent association included oropharyngeal procedures, underlying physical illness (American Society of Anesthesiologists class >or = 3), and the choice of intravenous versus intramuscular route. CONCLUSION: Risk factors that predict ketamine-associated airway and respiratory adverse events are high intravenous doses, administration to children younger than 2 years or aged 13 years or older, and the use of coadministered anticholinergics or benzodiazepines.

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Clinic for Surgery
DDC:610 Medicine & health
Language:English
Date:2009
Deposited On:23 Nov 2009 12:42
Last Modified:27 Nov 2013 16:27
Publisher:Elsevier
ISSN:0196-0644
Publisher DOI:10.1016/j.annemergmed.2008.12.011
PubMed ID:19201064
Citations:Web of Science®. Times Cited: 45
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Scopus®. Citation Count: 59

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