Intramuscular ketamine is superior to meperidine, promethazine, and chlorpromazine for pediatric emergency department sedation

Objective: To compare ketamine hydrochloride (KET) with combined meperidine hydrochloride, promethazine hydrochloride, and chlorpromazine hydrochloride (MPC) for pediatric emergency department sedation with respect to onset, duration and efficacy. Design: Prospective, randomized, double-blind clinical trial. Setting: Pediatric emergency department in an urban university hospital. Patients: Convenience sample of 29 patients, 6 months to 6 years of age, requiring sedation for suturing, wound or burn debridement, or lumbar puncture. Intervention: Children received intramuscular KET (4 mg/kg) with atropine sulfate (0.01 mg/kg) or MPC (meperidine hydrochloride 2 mg/kg, promethazine hydrochloride 1 mg/kg, chlorpromazine hydrochloride 1 mg/kg). Data collection included demographics, vital signs, and onset of sedation; procedural distress using the Observational Scale of Behavioral Distress; and time to recovery. The operator ws questioned on satisfaction with drug, and parents received follow-up to assess parental satisfaction. Results: Of the 29 patients enrolled in the study, 2 were excluded for protocol violation, 15 received KET, and 12 received MPC. Demographics and baseline vital signs did not differ. Although patients in the 2 groups had a similar duration of sedation (KET, 82 min vs MPC, 97 min, P=.15), patients receiving KET had more rapid onset of sedation (3 min vs 18 min, P<.01), a shorter time to discharge (85 min vs 113 min, P=.01) and lower Observational Scale of Behavioral Distress scores (9.9 vs 19.2. P=.003). All 15 physicians using KET would request it again vs 5 of 12 (42%) of the physicians using MPC (P<.001). No serious adverse reactions occurred. There were no differences in parental satisfaction. Conclusion: Ketamine has a faster onset and results in more rapid discharge from the pediatric emergency department, while providing for less patient distress during procedures. Ketamine is also associated with greater physician satisfaction than MPC.