Demonstrating the safety profile of ketamine as procedural conscious sedation in infants; a prospective cohort study of 904 cases

Conscious sedation has both a sedative and an analgesic effect. Ketamine is an increasingly popular choice for procedural conscious sedation in a paediatric day surgery. Ketamine is also cheaper than general anaesthetic. The objective of our study is to investigate the number of adverse events when using ketamine for procedural conscious sedation and demonstrate its safety profile for use in paediatric day surgery in a community setting in infants. A single-centre, single surgeon, single procedure 5-year longitudinal prospective review of 904 infants undergoing elective day-care surgery using ketamine for procedural conscious sedation between 2016 and 2020. Patients were stratified for pre-anaesthetic co-morbidities based on the American Society of Anesthesiologists (ASA) classification system. All patients were between 4 weeks and 1 year and 98.7% were ASA Class 1. Most children received ketamine intramuscularly and only one child required additional ketamine to maintain procedural conscious sedation. There were no serious adverse events and there were 27 mild adverse events in 26 patients (2.88% patients). The most common adverse event was hypersalivation, which occurred in 11 infants. Ketamine is a safe drug for procedural conscious sedation and should be considered more for infants undergoing elective day-care surgery provided that all staff conducting procedures have advanced training in paediatric and neonatal airway management and resuscitation.