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A Pilot Study Testing Intranasal Ketamine for the Treatment of Procedural Anxiety in Children Undergoing Laceration Repair

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Abstract

Identifying non-invasive methods for anxiolysis is becoming increasingly important in the pediatric emergency department (ED). Few studies have examined the use of intranasal (IN) ketamine for procedural anxiolysis. We aim to evaluate if IN ketamine provides satisfactory anxiolysis for patients undergoing laceration repair based on anxiety and sedation scoring. We also evaluated the feasibility of using IN ketamine in future trials based on its tolerability and side-effects. A pilot study evaluating IN ketamine in the treatment of procedural anxiety for patients, 2 years and older, weighing 40 kg or less, presenting to the pediatric ED with lacerations. The need for anxiolysis was defined by an elevated modified-Yale Preoperative Anxiety Scale—Short Form (mYPAS-SF) score. Patients received 5 mg/kg of IN ketamine in addition to topical anesthesia, mYPAS-SF scoring before and during the procedure, sedation scoring, adverse events, vital signs, age, weight, laceration size and location, and satisfaction surveys were recorded. Twenty-five patients were enrolled, with mean age of 61 ± 29.2 months and mean weight of 21 ± 6.4 kg. Lacerations were located on the face, extremities, and groin with mean size of 2.1 cm. A decrease in anxiety levels was observed, from median m-YPAS-SF score of 66.7 (62.50–80.2) to 33.3 (27.09–52.00), p < 0.001. Among the patients, 92% (n = 23) were less anxious during the procedure. IN ketamine appears to be safe and well-tolerated with a positive impact on procedural anxiety. A dosage of 5 mg/kg is a reasonable starting point, as 80% of patients had appropriate anxiolysis.

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Authors and Affiliations

  1. Pediatric Emergency Department, Arnold Palmer Hospital for Children, Orlando Health, 92 W. Miller Street, Orlando, FL, USA

    Thomas Cristoforo, Dulce Gonzalez, Mark Bender, Geraldine Uy, Mark Clark, Brandon Carr & Kelly Cramm

  2. Emergency Department, Orlando Regional Medical Center, Orlando Health, Orlando, FL, USA

    Mark Bender, Geraldine Uy, Linda Papa & Mark Clark

  3. Research Department, Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL, USA

    Bertha A. Ben Khallouq

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  1. Thomas Cristoforo
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Cristoforo, T., Gonzalez, D., Bender, M. et al. A Pilot Study Testing Intranasal Ketamine for the Treatment of Procedural Anxiety in Children Undergoing Laceration Repair. Journ Child Adol Trauma 15, 479–486 (2022). https://doi.org/10.1007/s40653-021-00402-9

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