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Observational Study
. 2017 Nov;58(11):660-665.
doi: 10.11622/smedj.2016187. Epub 2016 Dec 9.

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

Shruthi Suryaprakash  1 , Lai Peng Tham  1   2
Affiliations
Observational Study

Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

Shruthi Suryaprakash et al. Singapore Med J. 2017 Nov.

Abstract

Introduction: Emesis is one of the most common adverse events associated with ketamine sedation. However, its predictors have not been clearly studied among Asian children. This study aimed to determine the incidence and predictors of emesis in children undergoing intramuscular (IM) ketamine sedation in an emergency department (ED) in Singapore and to identify high-risk groups, so that antiemetics may be administered prophylactically.

Methods: In a prospective observational study, all children requiring procedural sedation with IM ketamine in the paediatric ED between 1 April 2013 and 31 January 2015 were included. All cases of emesis following ketamine sedation were prospectively documented. Univariate and multivariate logistic regression analyses were performed to identify the predictors of emesis.

Results: 2,502 sedations were performed using IM ketamine in the ED during the study period. Overall incidence of emesis associated with IM ketamine sedation was 8.4%. Children aged ≥ 8 years were significantly associated with increased risk of emesis (odds ratio 4.636, 95% confidence interval 3.271-6.570; p < 0.001), with an emesis rate of 19.6%. Other variables such as initial dose (3 mg/kg vs. 4 mg/kg), total dosage (including top-ups), type and site of procedure, gender and ethnicity were not significant predictors. The number needed to treat for antiemetics in children aged ≥ 8 years was five.

Conclusion: Age is a significant predictor of emesis. We recommend conducting a randomised controlled trial to compare the effects of prophylactic oral ondansetron in patients stratified into the age groups of ≥ 8 years and < 8 years.

Keywords: emesis; ketamine; paediatric; risk factor.

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Figures

Fig. 1
Fig. 1
Flowchart shows the inclusion process for the present study.
Fig. 2
Fig. 2
Bar chart shows the frequency distribution of emesis stratified by age of the children.
Fig. 3
Fig. 3
Bar charts show the proportion of procedures stratified by (a) age and site of procedure and (b) age and type of procedure. I&D: incision and drainage; M&R: manipulation and reduction; T&S: toilet and suture
See this image and copyright information in PMC

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