Paediatric procedural sedation in the emergency department: is ketamine safe?
Bibliographic record
Abstract
Procedural sedation and analgesia involve the use of one or more sedative and analgesic agents to relieve pain and anxiety and to control motor activity in patients undergoing diagnostic and therapeutic procedures.1–4 Administration of effective procedural sedation can maximise patient comfort, thus leading to a higher frequency of procedural success and it is also often linked with increased parental satisfaction with the emergency department (ED) experience, even though the administration of sedation can be associated with increased length of stay.1–4 Typical indications for procedural sedation include diagnostic imaging, fracture or dislocation reduction, wound care and repair of a laceration, incision and drainage of an abscess, lumbar puncture and placement of a central venous catheter.1–4 This paper will discuss the safety profile of ketamine when used in procedural sedation and how to prevent or manage ketamine sedation-related adverse events. Ketamine is N-methyl-D-aspartate receptor blocker, a dissociative agent chemically related to phencyclidine. It produces a trance-like cataleptic state of sensory isolation characterised by profound analgesia, sedation and amnesia while maintaining cardiovascular stability and preserving spontaneous respirations and airway reflexes.4 Ketamine undergoes hepatic metabolism to norketamine, an active metabolite with one-third of the analgesic potency of ketamine. It has a short duration of action and can be administered intravenously, intramuscularly or intranasally. The intravenous route is highly preferred in procedural sedation using ketamine. The onset of action of ketamine is rapid (1–2 min), the duration is brief (10–15 min) and the recovery time is short (30–60 min). The initial dose is 1–1.5 mg/kg, and an additional 0.5 mg/kg doses can be administered within the next 4 min and titrated to effect. The dose given should achieve and maintain dissociation. This is an important concept. Other drugs used for sedation in the ED will demonstrate a dose-response continuum, which generally involve more drug to achieve deeper …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".