The Factors of Ketamine that Affect Sedation in Children with Oncology Procedures: Parent Satisfaction Perspective
Chanchai Traivaree MD*, Wanchana Jindakam MD*, Chalinee Monsereenusorn MD*, Piya Rujkijyanont MD*, Rachata Lumkul MD*
Affiliation : * Division of Pediatric Hematology/Oncology, Department of Pediatrics, Phramongkutklao College of Medicine, Bangkok, Thailand
Background : The pain and its complication during sedation with ketamine remain a significant problem for children with
hematologic malignancy.
Objective : The purpose of the present study was to evaluate further the parental satisfaction for procedural sedation and
analgesia during pediatric hematology/oncology procedures performed by pediatrician in the Department of Pediatrics,
Phramongkutklao Hospital.
Material and Method: The authors prospectively evaluated our experience using intravenous ketamine 1 mg/kg for oncology
patients undergoing procedures at Department of Pediatrics, Phramongkutklao Hospital. The procedure was assessed by
way of a physician-completed form and by evaluation of questionnaires given to parents to estimate levels of pain by using a
0 to 10 mm visual analog scale (VAS) at 2 hours after procedures and results in any adverse events with respect to age,
gender, procedures performed, ketamine dosage and recovery time.
Results : Total of 46 children aged 6 months to 15 years with 46 procedures were observed at pediatric unit post-procedure.
The indications for procedural sedation and analgesia included lumbar puncture and intrathecal chemotherapy (50%), bone
marrow aspiration or biopsy (21.7%), and both procedures (28.3%). The median VAS scale during oncology procedures
was 3, which were expressed by all the parents/guardians of the children treated. Adverse effects were observed in all children
including nausea (30.4%), hypersalivation (26.1%), vomiting (21.7%), hallucination (4.2%). No child required admission
to hospital and there were no serious complications.
Conclusion : Intravenous ketamine 1 mg/kg is effective for invasive procedures in children with malignancy. The use of
intravenous ketamine may produce psychedelic effects in children. These adverse effects may alter the child’s comfort and
parental satisfaction especially in the young children.
Keywords : Ketamine sedation, Parent satisfaction, Hematology/oncology procedure
