Ketamine for kids

[shearernurse]

I work in a 16 bed rural hospital, we handle anything that walks through the door. From a hot M.I. to a mom @10cm. Tonight, we had a 2 1/2 year old kid, who was bitten on lthe face by a dog. After consulting with plastics in the city, they said we could do it here if the kid was sedated. We didn't have any TAC or LET, so we decided on Ketamine. He was 27lbs=12kg. Dose range was 6.5-13mg/kg, we chose on the side of caution and gave the kid 80mg, which is on the low side. It didn't take long to work, within 5 minutes the kid was out and the Dr. started suturing. Before we gave him the ketamine, I put him on a cardiac mointor and 02 sat machine. Within a few minutes of starting to suture, the kids respirations became stridorous and his 02 sats started to drop. We bagged him and he started breathing better on his own. Then he did it again, we bagged him again, this time when he started breathing, I put 02 on him at 3L. At one point, the doc asked me for an oral airway. I opened the Braslow bag and found everything but an OPA. We had 7 size 7's when I went back and checked the crash cart. The size 7's would have been for a 15 year old. What size would you use, for a 12kg kid? Is Ketamine really safe,? I had to go check my drawers when we were done, this scared the sh** out of me. Any info you have would be greatly appreciated, from all you PICU/ER/ANY nurses.

Thanks

[NotReady4PrimeTime, RN]

Ketamine is safe, but it's best saved for occasions where at least one person in the room is familiar with its effects. What you describe is always possible and should be planned for ahead of time. We use ketamine a fair bit in our unit here at the UofA, but we always have intubation equipment at the ready. As to OPAs, depending on the numbering system on your airways, you'd either need a 00 or a 4-5 for the patient you describe. Another side effect we sometimes see is hallucinations, which can be avoided by using a benzo with it. I hope this experience hasn't turned you off peds ER care...

[CRNA, DNSc]

I have induced general anesthesia on larger patients with 80 mg of ketamine- you could have started with a much smaller dose. THe listed dose IM for general anesthesia in pediatrics is only 5-6mg/kg and IV is only 1-2mg/kg.

[skipaway]

I work in a 16 bed rural hospital, we handle anything that walks through the door. From a hot M.I. to a mom @10cm. Tonight, we had a 2 1/2 year old kid, who was bitten on lthe face by a dog. After consulting with plastics in the city, they said we could do it here if the kid was sedated. We didn't have any TAC or LET, so we decided on Ketamine. He was 27lbs=12kg. Dose range was 6.5-13mg/kg, we chose on the side of caution and gave the kid 80mg, which is on the low side. It didn't take long to work, within 5 minutes the kid was out and the Dr. started suturing. Before we gave him the ketamine, I put him on a cardiac mointor and 02 sat machine. Within a few minutes of starting to suture, the kids respirations became stridorous and his 02 sats started to drop. We bagged him and he started breathing better on his own. Then he did it again, we bagged him again, this time when he started breathing, I put 02 on him at 3L. At one point, the doc asked me for an oral airway. I opened the Braslow bag and found everything but an OPA. We had 7 size 7's when I went back and checked the crash cart. The size 7's would have been for a 15 year old. What size would you use, for a 12kg kid? Is Ketamine really safe,? I had to go check my drawers when we were done, this scared the sh** out of me. Any info you have would be greatly appreciated, from all you PICU/ER/ANY nurses.

Thanks

Yep, way too much for this child.

[kids]

We had a lengthy discussion on ketamine use in the ER not long ago with a lot of the discussion relating to its use in children. https://allnurses.com/forums/showthread.php?t=56622