Pediatric Procedural Sedation and Analgesia with Ketamine and Adverse Events in the Emergency Department

Aim: Procedural Sedation and Analgesia (PSA) is crucial in pediatric emergency care to minimize discomfort, enhance procedural success, and improve satisfaction for both healthcare providers and caregivers. This study aims to evaluate the characteristics of pediatric patients who received ketamine for PSA in the emergency department (ED) and to assess associated adverse events.Material and Methods: This prospective observational study analyzed collected data from pediatric patients (3 months–18 years) who underwent ketamine-based PSA in the ED between June 21 and September 17, 2021. Data included demographics, nutritional status, ketamine dosing, oxygen support needs, and vital signs (e.g., blood pressure, oxygen saturation, respiratory rate, heart rate, end-tidal CO₂). Sedation levels (Ramsey Scale) and adverse events such as hypoxemia, apnea, hypercarbia, hiccups, hypersalivation, muscle twitching, vomiting, and transient apnea were recorded pre-, intra-, and post-procedure.Results: Sixty pediatric patients (mean age: 3.5 ± 1 years; 46 males, 76.7%) were included. Most (98.3%) were ASA I, with one (1.7%) classified as ASA II. No significant differences were noted in vital signs except for increased systolic and diastolic blood pressure. Adverse events included agitation (16.7%), hiccups (11.7%), muscle twitching (10%), hypersalivation (8.3%), vomiting (3.3%), clonus (1.7%), transient apnea (1.7%), and nystagmus (1.7%). No severe complications occurred.Conclusion: Although adverse events may occur during pediatric PSA with ketamine, serious events are rare. Ketamine demonstrates a favorable safety profile with no serious adverse events, confirming that single-agent PSA is a reliable practice in the pediatric ED when managed with appropriate clinical vigilance.