Prospective and retrospective observational case series of parenteral ketamine administrations in children (≤21 years) for procedural sedation in an emergency department setting were eligible for inclusion in the review.
The outcomes were emesis (an episode of vomiting during sedation or recovery before discharge) recovery agitation (any combination of agitation, crying, hallucinations and nightmares) and clinically important agitation (agitation leading to treatment or described as severe by investigators).
Predictor variables were intravenous versus intramuscular administration, initial dose, total dose, presence or absence of co-administered anticholinergics, presence or absence of co administered benzodiazepines, patient age, American Society of Anesthesiologists (ASA) physical status and presence or absence of oropharyngeal procedural indication (coded as present versus absent).
Two additional dichotomisations of ketamine technique were low dose (<3mg/kg) and high dose (initial dose ≥2.5mg/kg or total dose ≥ 5mg/kg) which had significant effects on respiratory adverse effects reported elsewhere (see Other Publications of Related Interest).
Exclusion criteria (described in the reference cited in Other Publications of Related Interest) were: no individual patient data (IPD) available; fewer than 20 patients; no measure of dose for each individual; and co-administration of propofol.
The median age of patients was 5.6 years. Median initial dose of ketamine was 3.9mg. Most of the included patients had an ASA physical status of one or two.
The authors did not state how many reviewers performed the study selection