Emergency Department Ketamine Sedation: Frequency and Predictors of Critical and High-Risk Adverse Events
Steven M. Green, Daniel S. Tsze, Mark G. Roback
Annals of Emergency Medicine, June 6, 2025
✅ Clinical Takeaways for EM Physicians:
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Ketamine is extremely safe as a sole agent for pediatric ED procedural sedation.
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Serious complications are exceedingly rare.
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Be cautious in older children (≥10) and if opioids are co-administered.
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Routine screening for URI or OSA should not preclude ketamine use based on this data alone.
🧪 Methods:
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Design: Retrospective registry analysis
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Dataset: 20 years of ED sedation data from the Pediatric Sedation Research Consortium
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Sample: 12,780 pediatric ketamine sedation encounters
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Focus: Sole-agent ketamine use
📊 Key Findings:
🚨 Critical Adverse Events:
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Extremely rare: 2 total cases (0.016%; 95% CI 0.0019–0.057%)
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One suspected aspiration (no desaturation, no intubation)
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One case of anaphylaxis requiring hospitalization
⚠️ High-Risk Adverse Events:
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Occurred in 67 cases (0.52%; 95% CI 0.41–0.66%)
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41 required positive pressure ventilation
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36 episodes of apnea
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7 cases of laryngospasm
🔍 Predictors of Adverse Events:
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Age ≥10 years
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Opioid co-administration
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Not predictive: Upper respiratory infections, OSA, or ASA status
Green, S.M., Tsze, D.S. and Roback, M.G., 2025. Emergency Department Ketamine Sedation: Frequency and Predictors of Critical and High-Risk Adverse Events. Annals of Emergency Medicine.