دورية أكاديمية
Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children.
| العنوان: | Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children. |
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| المؤلفون: | Green SM; Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA., Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M, Weiss M, Pitetti RD, Hostetler MA, Wathen JE, Treston G, Garcia Pena BM, Gerber AC, Losek JD |
| مؤلفون مشاركون: | Emergency Department Ketamine Meta-Analysis Study Group |
| المصدر: | Annals of emergency medicine [Ann Emerg Med] 2009 Aug; Vol. 54 (2), pp. 171-80.e1-4. Date of Electronic Publication: 2009 Jun 06. |
| نوع المنشور: | Journal Article; Meta-Analysis |
| اللغة: | English |
| بيانات الدورية: | Publisher: Mosby Country of Publication: United States NLM ID: 8002646 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6760 (Electronic) Linking ISSN: 01960644 NLM ISO Abbreviation: Ann Emerg Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: St. Louis, MO : Mosby Original Publication: [Lansing, Mich., American College of Emergency Physicians] |
| مواضيع طبية MeSH: | Emergency Service, Hospital*, Anesthetics, Dissociative/*adverse effects , Ketamine/*adverse effects , Psychomotor Agitation/*etiology , Vomiting/*chemically induced, Age Factors ; Anesthesia Recovery Period ; Anesthetics, Dissociative/administration & dosage ; Benzodiazepines/administration & dosage ; Child ; Child, Preschool ; Cholinergic Antagonists/administration & dosage ; Female ; Humans ; Infant ; Injections, Intramuscular ; Injections, Intravenous ; Ketamine/administration & dosage ; Male ; Risk Factors |
| مستخلص: | Study Objective: Ketamine is widely used in emergency departments (EDs) to facilitate painful procedures; however, existing descriptors of predictors of emesis and recovery agitation are derived from relatively small studies. Methods: We pooled individual-patient data from 32 ED studies and performed multiple logistic regression to determine which clinical variables would predict emesis and recovery agitation. The first phase of this study similarly identified predictors of airway and respiratory adverse events. Results: In 8,282 pediatric ketamine sedations, the overall incidence of emesis, any recovery agitation, and clinically important recovery agitation was 8.4%, 7.6%, and 1.4%, respectively. The most important independent predictors of emesis are unusually high intravenous (IV) dose (initial dose of > or =2.5 mg/kg or a total dose of > or =5.0 mg/kg), intramuscular (IM) route, and increasing age (peak at 12 years). Similar risk factors for any recovery agitation are low IM dose (<3.0 mg/kg) and unusually high IV dose, with no such important risk factors for clinically important recovery agitation. Conclusion: Early adolescence is the peak age for ketamine-associated emesis, and its rate is higher with IM administration and with unusually high IV doses. Recovery agitation is not age related to a clinically important degree. When we interpreted it in conjunction with the separate airway adverse event phase of this analysis, we found no apparent clinically important benefit or harm from coadministered anticholinergics and benzodiazepines and no increase in adverse events with either oropharyngeal procedures or the presence of substantial underlying illness. These and other results herein challenge many widely held views about ED ketamine administration. |
| فهرسة مساهمة: | Investigator: C Oktay; JP Saetta; V Holloway; P Heinz; AH Bleiberg; D Herd; SA Godambe; J Pershad; JD Luhmann; RM Kennedy; RJ Dachs; SJ Priestley; JP Acworth |
| المشرفين على المادة: | 0 (Anesthetics, Dissociative) 0 (Cholinergic Antagonists) 12794-10-4 (Benzodiazepines) 690G0D6V8H (Ketamine) |
| تواريخ الأحداث: | Date Created: 20090609 Date Completed: 20090811 Latest Revision: 20220316 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1016/j.annemergmed.2009.04.004 |
| PMID: | 19501426 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1097-6760 |
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| DOI: | 10.1016/j.annemergmed.2009.04.004 |