Procedural Sedation by Pediatric Hospitalists: Analysis of the Nature and Incidence of Complications During Ketamine and Nitrous Oxide Sedation

Objective: The goal of this study was to determine the nature and rate of complications during procedural sedation by pediatric hospitalists (PH) using ketamine and nitrous oxide (N₂O).

Methods: This study was a retrospective review and analysis of a quality improvement database for sedations performed by PH at St Louis Children’s Hospital from February 2007 to February 2013. Information was obtained on sedations performed and reported in the quality improvement database by PH over this time period using ketamine and N₂O.

Results: PH performed 8870 sedations from 2007 to 2013, 60.2% using ketamine and 39.8% using N₂O. Procedural completion rates were >99%; 0.12% of sedations were not completed due to inadequate sedation, and sedation level was not achieved in 1.71% of sedations. There were no occurrences of death, need for cardiopulmonary resuscitation, unplanned intubation, or emergency anesthesia consultation. The only major complications were 4 unplanned admissions, 2 each with ketamine and N₂O. With ketamine, the 2 highest rates of complications were airway repositioning (3.99%) and nausea and/or vomiting (2.98%). With N₂O, the 2 highest complication rates were nausea and/or vomiting (8.50%) and airway repositioning (1.10%). Respiratory and cardiovascular events were more frequently encountered with ketamine, whereas nausea/vomiting, sedation level not achieved, and inadequate sedation resulting in procedure not completed occurred more frequently with N₂O.

Conclusions: PH at St Louis Children’s Hospital successfully provided sedation by using ketamine and N₂O with low rates of complications for a variety of procedures.