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Ketamine sedation is not associated with clinically meaningful elevation of intraocular pressure. Am J Emerg Med 2012 Sep;30(7):1215-8

Date

12/16/2011

Pubmed ID

22169582

Pubmed Central ID

PMC3761376

DOI

10.1016/j.ajem.2011.06.001

Scopus ID

2-s2.0-84865527609 (requires institutional sign-in at Scopus site)   42 Citations

Abstract

BACKGROUND: Ketamine is widely used for procedural sedation, but there is limited knowledge on whether ketamine use is associated with elevated intraocular pressure (IOP).

OBJECTIVE: The aim of this study was to examine whether there are clinically important elevations of IOP associated with ketamine use during pediatric procedural sedation.

METHODS: We prospectively enrolled children without ocular abnormalities undergoing procedural sedation that included ketamine for nonperiorbital injuries. We measured IOP for each eye before and at 1, 3, 5, 15, and 30 minutes after initial intravenous ketamine administration. We performed Bland-Altman plots to determine if IOP measurements in both eyes were in agreement. Linear regression was used to model the mean IOP of both eyes as a function of time, dose, and age, with a robust sandwich estimator to account for repeated measures.

RESULTS: Among 25 participants, median (interquartile range) age was 11 (9-12) years, and 18 (72%) were male. Median ketamine dose was 1.88 mg/kg (interquartile range, 1.43-2.03 mg/kg; range 0.96-4 mg/kg). Bland-Altman plots demonstrated a mean difference of IOP between eyes near zero at all time points. The largest predicted difference from baseline IOP occurred at 15 minutes, with an estimated change of 1.09 mm Hg (95% confidence interval, -0.37 to 2.55). The association between ketamine dose and mean IOP was not statistically significant or clinically meaningful (P = .90; estimated slope, 0.119 [95% confidence interval, -1.71 to 1.95]). There were no clinically meaningful levels of increased measured average IOP reached at any time point.

CONCLUSIONS: At dosages of 4 mg/kg or less, there are not clinically meaningful associations of ketamine with elevation of IOP.

Author List

Drayna PC, Estrada C, Wang W, Saville BR, Arnold DH

Author

Patrick C. Drayna MD Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Anesthetics, Dissociative
Child
Conscious Sedation
Emergency Service, Hospital
Female
Humans
Intraocular Pressure
Ketamine
Male
Prospective Studies
Time Factors