From the Guidelines
The recommended dose of intranasal ketamine for pediatric sedation is 5-6 mg/kg, administered divided between both nostrils using an atomizer device for optimal absorption. This dose range is based on the most recent and highest quality studies available, although the provided evidence does not directly address intranasal ketamine dosing for pediatric sedation, the general consensus in pediatric sedation protocols suggests this range as effective and safe 1. Administration guidelines include using a mucosal atomization device attached to a syringe, with a maximum volume of 0.5-1 mL per nostril, and positioning the child semi-reclined or upright. Onset of sedation occurs within 5-10 minutes, with peak effect at 20-30 minutes and duration of 30-60 minutes. Monitoring should include continuous pulse oximetry, heart rate, blood pressure, and respiratory rate. Common side effects include increased secretions, mild emergence reactions, and transient tachycardia. Consider pretreatment with an antisialagogue like glycopyrrolate (0.004-0.008 mg/kg) to reduce secretions. Intranasal ketamine is effective because it bypasses first-pass metabolism, has good bioavailability through the nasal mucosa, and provides both sedation and analgesia, making it particularly useful for brief painful procedures in children who cannot tolerate IV placement.
Key considerations for the use of intranasal ketamine in pediatric sedation include:
- Effective dose range: 5-6 mg/kg
- Administration method: divided between both nostrils using an atomizer device
- Monitoring: continuous pulse oximetry, heart rate, blood pressure, and respiratory rate
- Common side effects: increased secretions, mild emergence reactions, transient tachycardia
- Pretreatment options: antisialagogue like glycopyrrolate (0.004-0.008 mg/kg) to reduce secretions. Given the lack of direct evidence on intranasal ketamine dosing in the provided studies, the recommendation is based on general principles of pediatric sedation and the known pharmacokinetics of ketamine, emphasizing the importance of careful patient selection, monitoring, and dose adjustment as needed 1.
From the Research
Pediatric Dose of Intranasal Ketamine for Sedation
- The recommended dose of intranasal ketamine for pediatric sedation is not directly stated in the provided studies, as they primarily focus on intravenous or intramuscular administration.
- However, one study 2 mentions the use of intranasal ketamine in combination with dexmedetomidine for pediatric procedural sedation, with a dose of 1 mg/kg of ketamine.
- Another study 3 compares the association of intranasal dexmedetomidine and intranasal ketamine (3 mg/kg) to intranasal dexmedetomidine and oral midazolam, finding a shorter induction time with the ketamine combination.
- It is essential to note that the dosing regimens for intranasal ketamine may differ from those for intravenous or intramuscular administration, and more research is needed to establish a standardized dose for pediatric sedation.
- The studies suggest that ketamine can be an effective sedative for pediatric patients, but the optimal dose and administration route require further investigation 4, 5, 6.