Ketamine Dosing for Pediatric Lip Laceration Repair
For pediatric lip laceration repair, ketamine should be administered at 1-1.5 mg/kg IV or 3-4 mg/kg IM, with IV administration being the preferred route when vascular access is available. 1
Dosing Recommendations
Intravenous (IV) Administration
- Initial dose: 1-1.5 mg/kg IV 1, 2
- Supplemental dosing: Additional 0.25-0.5 mg/kg if needed 3
- Onset of action: 1-2 minutes 1
- Duration: Typically 10-15 minutes
Intramuscular (IM) Administration
- Initial dose: 3-4 mg/kg IM 4
- Onset of action: 3-5 minutes (average 4.8 minutes) 2
- Duration: Typically 15-30 minutes
Adjunctive Medications
- Atropine: 0.01-0.02 mg/kg (to reduce secretions) 4
- Midazolam (optional): 0.05 mg/kg IV (if using IV ketamine) 1, 3
- Note: Adding midazolam does not decrease recovery agitation but may decrease emesis 2
Monitoring Requirements
- Continuous pulse oximetry (essential)
- Heart rate and blood pressure monitoring (every 5 minutes)
- Consider capnography for early detection of hypoventilation 1
- Close observation of respiratory status and level of consciousness
Expected Recovery Times
- IV ketamine: 65-85 minutes (range 22-215 minutes) 1
- IM ketamine: Approximately 90 minutes (range 60-130 minutes) 2
Special Considerations for Lip Lacerations
- Lip lacerations are among the most common indications for ketamine sedation in pediatrics (54.4% of cases in one large series) 4
- Lower doses of ketamine (0.5-1.0 mg/kg IV) may be sufficient for many pediatric patients, with studies showing 88% of patients can be successfully sedated with 1 mg/kg or less 3
- For oral/buccal/lip lacerations, special attention to airway protection is needed due to the proximity of the procedure to the airway
Adverse Events to Monitor
- Emesis: Occurs in approximately 7-14% of cases 2, 4
- Respiratory events: Hypoxemia (SpO₂ <90%) occurs in approximately 1.6% of cases with ketamine alone 1
- Recovery agitation: More common in younger children and those with higher ASA status 2
- Ataxia: May occur during recovery phase (7% of cases) 2
Alternative Non-Invasive Options
For minor lip lacerations or in cases where IV access is challenging:
- Oral ketamine: 6-10 mg/kg has shown efficacy, though with longer onset time (30 minutes) 5, 6
- Nitrous oxide: Consider as an alternative for cooperative children, with faster recovery times than ketamine 7
Discharge Criteria
- Return to baseline consciousness
- Stable vital signs
- Ability to maintain airway independently
- Adequate pain control
- Must be accompanied by a responsible adult 1
Remember that ketamine provides both sedation and analgesia through dissociative effects, with efficacy approaching 100% in clinical studies. The key is to use the lowest effective dose to minimize recovery time and adverse effects while achieving adequate sedation for the procedure.