Intranasal Ketamine for Procedural Sedation in Pediatric Laceration Repair A Preliminary Report

Objective: The objective of this study was to compare the efficacy of 3 doses of intranasal ketamine (INK) for sedation of children from I to 7 years old requiring laceration repair. Methods: This was a randomized, prospective, double-blind trial of children requiring sedation for laceration repair. Patients with simple lacerations were randomized by age to receive 3, 6, or 9 mg/kg INK. Adequacy and efficacy of sedation were measured with the Ramsay sedation score and the Observational Scale of Behavioral Distress Revised. Serum ketamine and norketamine levels were drawn during the procedure. Sedation duration and adverse events were recorded. Results: Of the 12 patients enrolled, 3 patients achieved adequate sedation, all at the 9-mg/kg dose. The study was suspended at that time as per predetermined criteria. Conclusions: Nine milligrams of INK per kilogram produced a significantly higher proportion of successful sedations than the 3- and 6-mg/kg doses.