Intramuscular ketamine is superior to meperidine, promethazine, and chlorpromazine for pediatric emergency department sedation
E. M. Petrack, C. M. Marx and M. S. Wright
Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio, USA.
OBJECTIVE: To compare ketamine hydrochloride (KET) with combined meperidine
hydrochloride, promethazine hydrochloride, and chlorpromazine hydrochloride
(MPC) for pediatric emergency department sedation with respect to onset,
duration, and efficacy. DESIGN: Prospective, randomized, double-blind
clinical trial. SETTING: Pediatric emergency department in an urban
university hospital. PATIENTS: Convenience sample of 29 patients, 6 months
to 6 years of age, requiring sedation for suturing, wound or burn
debridement, or lumbar puncture. INTERVENTION: Children received
intramuscular KET (4 mg/kg) with atropine sulfate (0.01 mg/kg) or MPC
(meperidine hydrochloride 2 mg/kg, promethazine hydrochloride 1 mg/kg,
chlorpromazine hydrochloride 1 mg/kg). Data collection included
demographics, vital signs, and onset of sedation; procedural distress using
the Observational Scale of Behavioral Distress; and time to recovery. The
operator was questioned on satisfaction with the drug, and parents received
follow-up to assess parental satisfaction. RESULTS: Of the 29 patients
enrolled in the study, 2 were excluded for protocol violation, 15 received
KET, and 12 received MPC. Demographics and baseline vital signs did not
differ. Although patients in the 2 groups had a similar duration of
sedation (KET, 82 min vs MPC, 97 min, P = .15), patients receiving KET had
more rapid onset of sedation (3 min vs 18 min, P < .01) a shorter time
to discharge (85 min vs 113 min, P 0 .01) and lower Observational Scale of
Behavioral Distress scores (9.9 vs 19.2, P = .003). All 15 physicians using
KET would request it again vs 5 of 12 (42%) of the physicians using MPC (P
< .001). No serious adverse reactions occurred. There were no
differences in parental satisfaction. CONCLUSION: Ketamine has a faster
onset and results in more rapid discharge from the pediatric emergency
department while providing for less patient distress during procedures.
Ketamine is also associated with greater physician satisfaction than MPC.
