Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

Abstract

Objectives: Outcomes associated with a sedative regimen comprised ketamine + propofol for pediatric procedural sedation outside of both the pediatric emergency department and operating room are underreported. We used the Pediatric Sedation Research Consortium database to describe a multicenter experience with ketamine + propofol by pediatric sedation providers.

Design: Prospective observational study of children receiving IV ketamine + propofol for procedural sedation outside of the operating room and emergency department using data abstracted from the Pediatric Sedation Research Consortium during 2007-2015.

Setting: Procedural sedation services from academic, community, free-standing children's hospitals, and pediatric wards within general hospitals.

Patients: Children from birth to less than or equal to 21 years old.

Interventions: None.

Measurements and main results: A total of 7,313 pediatric procedural sedations were performed using IV ketamine + propofol as the primary sedative regimen. Median age was 84 months (range, < 1 mo to ≤ 21 yr; interquartile range, 36-144); 80.6% were American Society of Anesthesiologists-Physical Status less than III. The majority of sedation was performed in dedicated sedation or radiology units (76.1%). Procedures were successfully completed in 99.8% of patients. Anticholinergics (glycopyrrolate and atropine) or benzodiazepines (midazolam and lorazepam) were used in 14.2% and 41.3%, respectively. The overall adverse event and serious adverse event rates were 9.79% (95% CI, 9.12-10.49%) and 3.47% (95% CI, 3.07-3.92%), respectively. No deaths occurred. Risk factors associated with an increase in odds of adverse event included ASA status greater than or equal to III, dental suite, cardiac catheterization laboratory or radiology/sedation suite location, a primary diagnosis of having a gastrointestinal illness, and the coadministration of an anticholinergic.

Conclusions: Using Pediatric Sedation Research Consortium data, we describe the diverse use of IV ketamine + propofol for procedural sedation in the largest reported cohort of children to date. Data from this study may be used to design sufficiently powered prospective randomized, double-blind studies comparing outcomes of sedation between commonly administered sedative and analgesic medication regimens.

Figure 1.

Percentage of adverse events (AEs) and serious AEs (SAEs)by location of sedation. The lines represent the baseline percentage of AE (solid) and SAE (dashed) of the entire ketamine + propofol cohort Other location includes operating room, endoscopy suite, or radiation oncology unit

Figure 2.

Percentage of adverse events (AEs) and serious AEs (SAEs) by coadministration of adjunctive medications. The lines are the baseline percentage of AE (solid) and SAE (dashed) of the entire ketamine + propofol cohort Only eight sedation encounters reported coadministration of a barbiturate with ketamine + propofol, and there were no SAE reported for this combination of medications.