Morton, N.S. (2008) Ketamine for procedural sedation and analgesia in pediatric emergency medicine: a UK perspective. Paediatric Anaesthesia, 18(1), pp. 25-29. (doi: 10.1111/j.1460-9592.2007.02395.x)
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Abstract
Procedural sedation and analgesia (PSA) techniques for pediatrics are developing rapidly (1,2) but there are still tensions amongst specialties with regard to safe implementation, autonomy, and limits of practice, competences, training and credentialing. Practice varies around the world and even within countries, and an important factor is availability of pediatric anesthesiology services to undertake large numbers of cases under anesthesia. In the United Kingdom (UK), some regions have these services well organized and the demand for pediatric PSA is quite limited. Other regions or individual centers have a relative shortage of pediatric anesthesiology provision or hotspots of high demand, for example for diagnostic imaging, and this can only be met by introducing a pediatric PSA service. An example from the UK is the nurse-led pediatric sedation service at Great Ormond Street Hospital (3,4). Another clinical pressure point in the UK is in Emergency Medicine with 4-h waiting time targets and reduction in availability of primary care out-of-hours services. Drawing on experience from the USA (5) and Australia, a number of enthusiasts in the UK have introduced PSA with ketamine into their pediatric emergency medicine practices and have argued cogently for its more widespread use (5–10). Not all agree however that the UK is ready for this yet (11) and in the Scottish pediatric procedural sedation guidelines, ketamine is regarded as a general anesthetic agent for use by anesthesiologists (12). There are no universally agreed national guidelines in the UK for pediatric PSA and this has led to the proliferation of a number of specialty-specific guidelines, including in pediatric emergency medicine (13). This article reviews the problems of introducing ketamine for PSA in pediatric emergency medicine in the UK.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Morton, Dr Neil |
| Authors: | Morton, N.S. |
| Subjects: | R Medicine > RD Surgery R Medicine > RJ Pediatrics |
| College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities |
| Journal Name: | Paediatric Anaesthesia |
| ISSN: | 1155-5645 |
| ISSN (Online): | 1460-9592 |
| Published Online: | 11 December 2007 |
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