The outcome of Ketamine and Propofol for Procedural Sedation and Analgesia (PSA) in Pediatric Patients in the Emergency Department: A Cross-Sectional Study

Abstract

Objectives: We aim to evaluate the outcomes of Ketamine and Propofol for PSA in pediatric Pakistani Emergency Department (ED) patients. Our primary objective is to observe sedation duration and recovery time. Secondary objective is to assess the need for repeat doses and potential complications associated with the use of these drugs. Study Design & Setting: Descriptive cross-sectional study. Urban tertiary care hospital: Aga Khan University Hospital (AKUH) ED, Pakistan. Methodology: 179 eligible patients requiring painful procedures in the emergency, under 16 years, selected through non probability consecutive sampling, after consent from caregiver/children, were included. PSA was performed by certified PALS and PSA personnel, with single IV Ketamine dose (0.5 mg/kg) and Propofol (1 mg/kg, followed by 0.5-1 mg/kg as needed). 15 Oxygen saturation and vital signs were continuously monitored during and after the procedure until full consciousness was regained and patients were observed for potential complications. RESULTS: 179 patients underwent PSA with Ketamine and Propofol combination; (57.0%) male and (43.0%) female, with a mean age of 3.91 years (± 2.80). Majority of patients were 1-5 years old (80.4%), 6-10 years (15.6%), and 11- 16 years (3.9%). Of these, (82.1%) required laceration repair. Some reversible complications were observed, including tachypnea in (28.5%) of cases, hypotension (22.3%), tachycardia (21.8%), bradycardia (2.2%) and hypoxia in (1.1%). CONCLUSION: In our study, PSA using Ketamine and Propofol combination in the ED, by non- anesthesiologists, was found to be safe and linked to a low rate of reversible complications.