Procedural Sedation in Children

Ketamine is commonly used in hospitals for sedation in children. There are some special features about sedation with ketamine for you to know.

• Your child will be cared for by a senior doctor and nurse.
• Ketamine is given by injection into a vein or into the muscle of the thigh.
• Your child may seem to be awake after receiving ketamine.
• Your child may move a little for no reason, this is normal.
• Your child’s eyes may twitch, this is normal.
• Your child may report odd dreams on waking up and may become a little agitated (less than 20% of children experience this) . This tends to improve if you comfort your child in a quiet area until he or she is fully awake.
• One in ten children develop a rash.
• One in ten children vomit.
• One in ten children will have some eye watering, or may drool.
• One in twenty children have some twitching movements.
• Rarely (in 0.3 % of cases), there may be laryngospasm (t he vocal cords close).
• Very rarely (in 0.02% of cases) children may need to be given a general anaesthetic with a breathing tube placed in their windpipe.

Propofol is often used for sedation in adults and may be used in older children/teenagers.

Propofol works quickly and also wears off soon after the procedure is finished.

Complications may include pain around the injection site (into a vein), low blood pressure and ineffective breathing. In rare cases the doctor may need to support your child’s breathing or place a breathing tube in their windpipe.

Your child will be carefully monitored throughout the procedure and be given oxygen to breathe through a mask. Your child will probably have no memory procedure or the sedation once they are awake.

Midazolam may also cause amnesia and in rare cases require breathing support. Your child may be drowsy for some time afterwards.

Before the procedure

• Ask the doctor or nurse to explain the procedure to you and to your child. If you do not understand please tell us.
• Talk to your child about some ways to cope (for example, looking at a book, using their imagination to be in a nice place or blowing bubbles).
• Try not to be too upset or nervous yourself as your child will notice this.

During the procedure

• A parent (or another adult who knows your child) may stay with them and this is usually helpful for your child.
• Depending on how deeply sedated your child becomes, they may need reminders of the coping methods you talked about earlier. This sort of distraction is very helpful.
• Giving your child a sense of control with some simple choices is helpful. We can allow them to choose things they may like such as which finger or toe the oxygen probe is placed on.
• It is not helpful to allow your child to decide the exact moment the procedure is going to happen.

After the procedure

• Remain with your child. They may not remember where they are or why they are in hospital.
• Focus on the good things your child did.

Sometimes the delayed effects of the medicines may make your child a bit confused, sleepy or clumsy. You need to be extra careful when caring for and supervising your child for the next 24 hours.

• Most children recover within 90 minutes. Your child will be safe to go home when they are fully awake, can walk unaided and manage to drink without vomiting. Once home they should be carefully supervised for the first eight hours and avoid strenuous play or sporting activity for 24 hours.
• Supervise all playing and bathing for the next eight hours after getting home. Do not let your child swing or use play equipment (bikes, monkey bars etc) that might cause an accident for the next 24 hours.
• Sometimes children may feel sick or vomit if they eat a big meal too soon after sedation. Give your child small amounts of clear liquids such as diluted fruit juice, ice lollies, jelly, clear soup etc and wait two hours before giving them a meal.
• Let your child sleep. Children may go to sleep again after getting home from the hospital. Sometimes children may sleep more because of the sedation medicine, this is normal.

If you have concerns that your child may be experiencing problems relating to the sedation they have received, please contact the Emergency Department at Ipswich Hospital on 01473 702033 and ask to speak to a senior doctor or nurse.