Ketamine is well reported as being safe to use in providing analgesia, sedation and amnesia in paediatric populations. This prospective, randomised, double-blinded study aimed to establish an optimum dose of ketamine in burns treatment settings in children aged six months to four years old. Pain assessment was undertaken using the Face, Legs, Activity, Cry, Consolability (FLACC) behavioural scale. The study included ninety children who required at least three burns dressings procedures (irrespective of total body surface area of burn), randomly allocated to one of three doses considered safe and efficacious: 4mg/kg, 6mg/kg or 8mg/kg. A fixed dose of midazolam was given alongside the ketamine to mitigate against possible side effects of ketamine, e.g. agitation and dysphoria. The authors suggest that a dose of 6mg/kg of rectal ketamine for burns dressings changes of 30 minutes or less provides optimum analgesia while providing a higher degree of feasibility in undertaking the procedure, with a shorter recovery time and fewer side effects. In addition, the rectal route of administration was preferred by the authors, who listed objections to the other methods of administration specific to the paediatric population, in particular the siting of intravenous lines which could cause psychological trauma in this group of patients. The authors suggest this dose is generalisable to other demanding paediatric procedures.

Rectal Ketamine during paediatric burn wound dressing procedures: a randomised dose-finding study.
Grossman B, Nilsson A, Sjoberg F, Nilsson L.
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Katie R Hilder

St John’s Hospital, Livingston.

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