UMEM Educational Pearls

Title: Ketamine - IM or IV? (submitted by Floyd Howell, MD)

Keywords: sedation, ketamine (PubMed Search)

Posted: 1/6/2012 by Mimi Lu, MD
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There are limited direct comparisons of (intravenous (IV) vs. intramuscular (IM) ketamine for pediatric procedural sedation in the emergency department. The only RCT comparing IV and IM ketamine was by Roback et al. and compared an IV dose of 1mg/kg vs. IM 4mg/kg. The study authors reported less procedural pain with IM administration compared with IV. However, vomiting occurred more frequently in the IM group, 26.3% compared to 11.9% in the IV group and recovery time was 49 minutes shorter with IV vs IM use.

Bottom line: Ketamine may be administered via both IM and IV routes. IM administration is associated with higher incidence of vomiting, may require repeat dosing, and is associated with longer recovery times. Age greater than 5 years may predispose to a higher incidence of vomiting. However, it may be useful for minor procedures where IV access may be difficult or traumatic for the patient.

Route Onset Duration Dose

IM 3-5 min 20-30min 3-5 mg/kg

IV 1 min 5-10 min 1-2 mg/kg

References:

1) Deasy C, Babl F. Intravenous vs intramuscular ketamine for pediatric procedural sedation by emergency medicine specialists: a review. Pediatric Anesthesia 2010; 20:787--96.

2) Clinical Procedures in Emergency Medicine, 4th Edition (2004).

3) Green SM et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med. 1998 Jun;31(6):688-97.

4) McGlone R. Emergency sedation in children. Utility of low dose ketamine. BMJ. 2009 Dec 22;339.

5) Roback MG et al. A randomized, controlled trial of i.v. versus i.m. ketamine for sedation of pediatric patients receiving emergency department orthopedic procedures. Ann Emerg Med. 2006 Nov; 48(5):605-12.