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TIL: a mini 
on one of my FAVORITE 
s used in the 
...KETAMINE! Ketamine is an NMDA antagonist that can be used for pediatric sedation. Ketamine produces a dissociative state while also having analgesic properties! Here’s a picture of me beaming before procedural sedation!
on one of my FAVORITE s used in the ...KETAMINE! Ketamine is an NMDA antagonist that can be used for pediatric sedation. Ketamine produces a dissociative state while also having analgesic properties! Here’s a picture of me beaming before procedural sedation!
In our pediatric population 
, 1 mg/kg can be administered IV followed by 0.5 mg/kg resides for adequate sedation during a procedure . No IV access? No PROBLEM! Ketamine can be given in many other routes...
, 1 mg/kg can be administered IV followed by 0.5 mg/kg resides for adequate sedation during a procedure . No IV access? No PROBLEM! Ketamine can be given in many other routes...
For pain and sedation we can utilize IN 
ketamine! 1 mg/kg for pain or 4 mg/kg IN for sedation has been utilized. however, only 0.5 mL/nostril should be given for optimal absorption. Did you see our recent 
”Boogie Board” on pediatric IN medication administration?
ketamine! 1 mg/kg for pain or 4 mg/kg IN for sedation has been utilized. however, only 0.5 mL/nostril should be given for optimal absorption. Did you see our recent ”Boogie Board” on pediatric IN medication administration?
If IVor IN isn’t optimal for your patient... Don’t fret! Ketamine can be given IM! Most commonly a dose of 4 mg/kg IM has been utilized for sedation! 
or IN isn’t optimal for your patient... Don’t fret! Ketamine can be given IM! Most commonly a dose of 4 mg/kg IM has been utilized for sedation!
You may have heard of an 
emergence reaction that occurs with the use of ketamine! Dim lighting, 
quiet location, and having your patient “think 
HAPPY thoughts” can all help mitigate this phenomena. Its important to set the tone for a positive experience....
emergence reaction that occurs with the use of ketamine! Dim lighting, quiet location, and having your patient “think HAPPY thoughts” can all help mitigate this phenomena. Its important to set the tone for a positive experience....
Talking about a show or something your patient really enjoys seems to be beneficial in my experience! Even pulling out your phone and youtubing Spongebob 
or baby 
has done wonders for calming our 
pediatric friends prior to induction
or baby has done wonders for calming our pediatric friends prior to induction
Historically, ketamine has been 
avoidedin adults because of this emergence reaction (but can be mitigated w/ BDZ). Pediatric patients are RESILIENT 
& it appears that this reaction phenomena is VERY rare in those < 10 years old during the recovery phase
avoidedin adults because of this emergence reaction (but can be mitigated w/ BDZ). Pediatric patients are RESILIENT & it appears that this reaction phenomena is VERY rare in those < 10 years old during the recovery phase
Another reason why I 
ketamine is because our is an excellent option for sedation/induction in patients with asthma 
as it 
bronchospasm. this is caused by 
in catecholamines, direct smooth muscle dilation and of vagal outflow.
ketamine is because our is an excellent option for sedation/induction in patients with asthma as it bronchospasm. this is caused by in catecholamines, direct smooth muscle dilation and of vagal outflow.
Some patients may experience nausea, pretreating with ondansetron prior to ketamine administration can 
in our pediatric friends. We should also monitor for laryngospasm (although rare), increased secretions and HR.
in our pediatric friends. We should also monitor for laryngospasm (although rare), increased secretions and HR.
Some pts experience nystagmus 
or ataxia, but those are usually self limiting!
I hope that this thread helps you appreciate ketamine and all it’s wonder, especially in the ED setting!
or ataxia, but those are usually self limiting! I hope that this thread
helps you appreciate ketamine and all it’s wonder, especially in the ED setting!
PMID: 15107362, 25447557, 2203290
-Tori
