Effect of sedation using Ketamine for primary closure of pediatric facial laceration

• Published in: Medicine (Baltimore) 2022-08, Vol.101 (32), p.e29924-e29924
• Main Authors: Lee, Ju Ho, Woo, Sang Seok, Shin, Se Ho, Kim, Hyeon Jo, Kim, Jae Hyun, Kim, Seong Hwan, Suh, In Suck
• Format: Article
• Language: English
• Subjects: Child; Conscious Sedation - methods; Facial Injuries; Humans; Hypnotics and Sedatives - therapeutic use; Infant; Ketamine - therapeutic use; Lacerations - surgery; Midazolam; Observational Study; Pain
• ISSN: 1536-5964; 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000029924

Pediatric lacerations are frequently encountered by plastic surgeons in the emergency room. Since pediatric patients cannot cooperate due to the anxiety and pain occurring during the suture procedure, sedation is induced. Since commonly used drugs inducing shallow sedation such as chloral hydrates are insufficient to perform procedures, the need or deep sedation has been increased. In our experience, inducing sedation with ketamine is safe and allows for accurate procedures. A total of 106 pediatric patients aged between 3 months to 5 years who visited the emergency room between August 2020 and January 2021 were included in this study. Of the 106 patients, 54 were sedated using ketamine, and the remaining 52 patients who did not cooperate were operated under local anesthesia, and these were set as the control group. The patients were intravenously injected with ketamine 1.5–2.0 mg/kg ketamine while monitoring the blood oxygen saturation, end-tidal CO2, and other vital signs. The patients were discharged as a complete awakening was confirmed by physicians. The number of patients who received sedation induced by ketamine was 54 and the number of patients who underwent the procedure without sedation was 52. The mean induction time of a single injection was 35.3 ± 11.3 minutes, and that of additional injection was 253.5 ± 54.1 minute. The total procedure time of the ketamine group was 20.3 ± 11.85 minutes, and that of the nonketamine group was 19.31 ± 10.50 minutes (P = .454). No statistically significant differences were found between the 2 groups. The need for sedation during the suture procedure in an emergenc9y room has been arising not only for reducing pain and anxiety, but also for safe and accurate procedures and scar minimization. Based on the parental satisfaction and the safety of the procedure, using ketamine is more effective than other drugs and should be used more actively.