Ketamine sedation

Why does my child need sedation?

Your child needs sedation because they are due to have a procedure that may be painful or distressing. This could be something like cleaning and stitching a wound, or repositioning a broken bone.

Sedation can make your child sleepy and relaxed and it aims to reduce your child’s distress during the procedure. We often use a medication called ketamine for the sedation.

What is ketamine?

Ketamine is a medication commonly used in hospitals for sedation in children that need a procedure that may be painful or unpleasant. It also is a pain-killing drug and results in your child not remembering the procedure (amnesia). Ketamine is the safest and most effective choice of sedative for children in the Emergency Department who require a short procedure.

What does ketamine do?

The medication is injected into the vein via a drip. Within 5 minutes, your child’s eyes will glaze over, and they will stop responding to you. They will still be breathing normally, and may appear awake, but they will be unaware of their surroundings. You may also notice their eyes watering or twitching movements of the eyes, and drooling of saliva — these are normal features of ketamine sedation.

This lasts for 20 to 40 minutes. During this time, we will undertake the proposed procedure. Your child will then begin to notice you again, and recovery will continue over the next hour or so.

What are the side effects?

We will go through a checklist with you before the procedure, but ketamine is very safe when used appropriately. The table below explains the possible side effects and how common these are.

What happens before the procedure?

We will ask you to sign a form documenting your consent. Your child will be weighed so that we can accurately calculate the dose of ketamine.

We will move your child to a monitored area so that we can do the procedure and monitor them closely. A drip will be inserted which will allow us to give any medication they need. Most commonly ketamine will be given as an injection into the drip, however sometimes we inject the ketamine into the thigh muscle.

A sensor (pulse oximeter) will be put on your child’s finger or toe with elastic tape to measure their oxygen levels and heart rate. A blood pressure cuff will also be placed on their arm to check their blood pressure.

If a wound is being closed, the doctor will inject local anaesthetic into the wound before stitching it which will provide some pain relief after the procedure too.

You do not have to stay with your child if you do not want to. We understand that some parents or carers may be too nervous or upset. However it would help your child and us if you stay until the injection is given and they start to get sleepy.

Why is there so much equipment?

This is a safety precaution as any sedation can cause breathing or blood pressure problems — this is very rare. The doctor and nurse present are experienced and trained in sedation and use of the equipment. There may also be a mask to deliver oxygen or a suction tube to remove saliva.

Is there an alternative?

Your child may already have been given some painkillers, and your presence is comforting. However many young children are unable to relax enough to tolerate injection of local anaesthetic, stitching, or removal of foreign bodies, all of which can be painful and require the child to be still.

The possible alternatives to sedation:

General anaesthetic

A general anaesthetic requires a hospital admission and often an overnight stay. General anaesthesia also carries a small risk of breathing or blood pressure problems. Injections are still required.

Entonox and distraction

This involves using toys or distraction and Entonox (‘laughing gas’ or ‘gas and air’) without sedation. However, if the child becomes distressed or moves too much to allow the procedure we would either have to restrain them, or abandon the procedure.

What happens after the procedure?

At the end of the procedure your child may be placed on their side. During this period your child may appear confused, distressed, say inappropriate words, sing or cry as they wake up. This is short lasting and will settle as they wake up.

If your child gets agitated, we can give them medications to help them slowly recover from their ketamine injection. This is rare and often not needed. Most often, keeping them calm and relaxed whilst they are coming round from the sedation will be enough.

After approximately 30 minutes from the injection your child can be transferred to the playroom or trolley area, unless a 2nd dose of ketamine has been given. Your child will be allowed home once they fully recognise you, can walk unaided, and manage to drink without vomiting. This will normally take at least 90 minutes. During this period please encourage your child to stay calm and still as rapid movements may precipitate an episode of vomiting.

What precautions should we take at home?

At home they should not walk independently for the first 2 hours after discharge. They should only sip clear fluids should be allowed during this time, otherwise they can be sick (vomit). Your child may appear to be mildly ‘drunk’ for this period.

For the first 8 hours they should be supervised closely, and avoid playing unobserved, using play equipment (bike, monkey bars, climbing frames etc), avoid swimming, or riding a bike for at least 24 hours.

If it is bedtime, be careful they cannot get up and wander in the night, as they may still be unsteady. Many parents prefer to put the child in their own bed, and this can be comforting for the child and reassuring for the parents.

Will my child still need pain relief?

If the procedure involves some potential ongoing pain such as stitching a wound, they may need some paracetamol or ibuprofen at home. Please see our resource for more information on pain relief.

What should I do if I am worried about my child at home?

If you are worried about your child after they have had a procedure requiring sedation please bring them back to the Emergency Department or call 111 for advice.