Paediatric ketamine sedation parental information sheet

Your child may become distressed or have pain when having certain procedure (tests or treatments). Sedation for procedures (procedural sedation) aims to reduce your child's pain and anxiety. The sedation may make your child feel sleepy and relaxed, meaning the procedure can be performed more easily and with less distress for you and your child. Your child may not remember the procedure at all or only remember small amounts only. This is normal.

Ketamine is commonly used in hospitals for sedation in children. There are some special features about sedation with ketamine for you to know:

• Your child will be cared for by a senior doctor and nurse
• It is given by injection into a vein or into the muscle of the thigh
• Your child may seem to be awake after receiving ketamine
• Your child may move a little without obvious cause, this is normal
• Your child’s eyes may twitch, this is normal
• Your child may report odd dreams on waking up, and may become a little agitated (less than 20% of children experience this). This tends to improve if you comfort your child in a quiet area until they are fully awake
• One in ten children develop a rash
• One in ten children vomit
• One in ten children will have some eye watering, or may drool
• One in twenty children have some twitching movements
• Rarely (0.3%) there can be laryngospasm (vocal cords close)
• In 0.02% of cases your child may need to be given a general anaesthetic with a breathing tube placed in their windpipe.

Before the procedure

• Ask the doctor/ nurse to explain the procedure to you and to your child. If you do not understand please tell us
• Talk to your child about some ways to cope (for example — looking at a book, using their imagination to be in a nice place or blowing bubbles)
• Try not to be too upset or nervous yourself as your child will notice this.

During the procedure

• A parent (or another adult) who knows your child may stay with them and this is usually helpful for your child
• Depending on how deeply sedated your child becomes, they may need reminders of the coping methods you decided upon earlier. This sort of distraction is very helpful
• Giving your child a sense of control with some simple choices is helpful. We can allow them to choose things they may like e.g. music and which finger the oxygen probe may be placed on
• It is not helpful to allow your child to decide the exact moment the procedure is going to happen.

Following the procedure

• Remain with your child. They may not remember where they are or why they are in hospital.
• Focus on the good things your child did.

After you go home

• Sometimes the delayed effects of the medicines may make your child a bit confused, sleepy or clumsy. You need to be extra careful in caring for and supervising your child for the next 24 hours.
• Most children recover within 90 minutes. Your child will be safe to go home when they are fully awake, can walk unaided and manage to drink without vomiting. Once home they should be closely supervised for the first 8 hours and avoid strenuous play or sporting activity for 24 hours
• Supervise all playing and bathing for the next 8 hours after getting home. DO NOT let your child swim or use play equipment (bikes, monkey bars etc) that might cause an accident for the next 24 hours.
• Sometimes children may feel sick or vomit if they eat a big meal too soon after sedation. Give your child small amounts of clear liquids such as diluted fruit juice, ice lollies, jelly, clear soup etc. and wait two hours before giving them a meal
• Let your child sleep. Children may go to sleep again after getting home from the hospital. Sometimes children may sleep more because of the sedation medicine; this is normal
• If you have any concerns that your child may be experiencing problems relating to the sedation that they have received, please contact the local Emergency Department¹ to discuss the issues with a senior doctor or nurse.

1. Adapted from The College of Emergency Medicine Guideline for ketamine sedation of children in emergency departments 2010.