Anesthesiology

The study find that the Ketamine, an N-methyl-d-aspartate receptor antagonist, is a valuable tool uniquely equipped to accomplish these tasks when used as a sub hypnotic infusion because of its analgesic properties at low doses. The American Society of Regional Anesthesia and Pain Medicine consensus guidelines on the use of intravenous ketamine infusions for acute pain management recently advocated for the use of ketamine in perioperative settings as both a stand-alone treatment and as an adjunct to opioids for pain control given its ability to minimize opioid consumption and reduce pain scores.

Intravenous ketamine infusion

Although ketamine is most often use in pediatrics for procedural sedation; there is also a role for its use in the treatment of pediatric pain. In a recent study of patients undergoing adenotonsillectomy;l ketamine significantly reduced pain scores at 30 minutes and 6  hours post-surgery. Ketamine resulted in improved pain scores and reduced opioid consumption for pediatric patients with sickle cell crises as well as those with severe cancer-related mucositis.

In chronic pain pediatric patients, over one-third had a 20% or greater reduction in pain scores from baseline with ketamine infusions. Despite these analgesic advantages; the use of low-dose ketamine infusions ;(≤0.3 mg/kg/hour) for pain control is often relegate to units that can provide higher levels of care ;(intensive care unit; post-anesthesia care unit) because of known side effects associated with higher doses; (ie, central nervous system excitation, sedation, hemodynamic changes).

Low-dose ketamine

Limiting the use of  infusions to specialized units is cost-prohibitive and may restrict patient access.  The acute pain service at our institution has been treating pediatric pain with this drug in non-critical care units for several years. We aim to present the characteristics of our ;clinical practice using sub anesthetic racemic  infusions in lower acuity units for pediatric pain management; and detail its impact on opioid consumption; pain scores and related side effects.

Data on all patients’ ages 0-21 years who received a low-dose ketamine infusion (≤0.3 mg/kg/hour); outside of the intensive care unit between  September 2012 and 30 September 2017 at Children’s Hospital Colorado are retrospectively analyze. While studies in the pediatric literature tend to limit age to 18 years; the American Academy of Pediatrics has recognized the upper age limit of the pediatric patient as age 21 since 1988 ;(AAP Policy Statement 2017); and more recently, has suggest that exceptions beyond this age limit should be made in cases where children have special healthcare needs.