Ketamine Sedation in Children
Ketamine is the emergency-department procedural‑sedation agent of choice for many paediatric short, painful or frightening procedures because it provides potent analgesia and amnesia while usually preserving airway reflexes, spontaneous ventilation and haemodynamic stability. Safe use requires structured patient selection, appropriate staffing and equipment, and continuous monitoring (RCEM; NICE CG112).
Indications
Ketamine is appropriate for short procedures where dissociative sedation is needed and the ED can provide monitored care, for example:
- Laceration repair (sutures)
- Removal of foreign bodies (ears, nose, superficial ocular foreign bodies)
- Orthopaedic procedures: joint relocation, closed fracture manipulation, joint aspiration
- Other brief painful procedures when adequate analgesia alone (paracetamol/ibuprofen, topical anaesthesia, intranasal opioid) or inhaled nitrous oxide is unlikely to suffice
Before choosing ketamine, consider whether non‑dissociative options (analgesia only, intranasal opioid, Entonox) are adequate.
Contraindications and situations requiring anaesthetic review
Follow local protocols and RCEM/NICE guidance. Typical absolute exclusions for ED ketamine include:
- Age below the local service minimum (commonly <12 months; some services extend exclusion to <24 months unless anaesthetist‑led)
- Active lower respiratory infection or uncontrolled asthma
- Unstable or anatomically abnormal airway (e.g., recent tracheal surgery, significant stenosis)