(659) Hemodynamic Safety of Ketamine for Procedural Sedation in Pediatric Burn-Injured Patients

Introduction: Standard care of burn wounds includes frequent debridement and dressing changes. These procedures are often performed under sedatives like ketamine. Ketamine directly stimulates the central nervous system, thus increasing systemic and pulmonary blood pressures, heart rate, and cardiac output. There is no current data in the literature assessing long-term effects of intravenous ketamine used during procedural sedation on blood pressure in children. We hypothesized that patients receiving ketamine for procedural sedation may develop elevated blood pressures during their burn unit admission and at outpatient follow up, and that multiple administrations of ketamine for dressing changes increases the risk of long term elevated blood pressure.

Methods: This retrospective observational study used patient data from electronic medical records at an urban tertiary care children’s hospital with a burn center. Patients admitted between 2020-2022 to the burn unit who received ketamine were compared to patients who were only seen in outpatient burn clinic and never received ketamine. Blood pressures at baseline, during sedation, prior to discharge, and at follow-up clinic were collected. We defined elevated blood pressure as readings > 90th percentile in patients 0-12 years old and systolic blood pressure between 120-129 and diastolic less than 80 in patients 13 years or older.

Results: Data was collected on 140 inpatients and 96 outpatients. There were no statistically significant differences in incidence of elevated blood pressure amongst inpatients who received ketamine one, two to four, or five and greater times. There was a statistically significant difference in incidence of elevated blood pressure between inpatients who had received ketamine and outpatients who never received ketamine (66.4% vs 51%, p = 0.0198). There are several confounding factors that may contribute, including the stress of a hospital stay. Very few patients were discharged home on anti-hypertensive agents, implying a transient and multi-factorial increase in elevated blood pressure.

Conclusions: This study points towards a slightly higher risk of long term elevated blood pressures in the setting of receiving ketamine for sedation purposes, but that ketamine likely remains a relatively safe medication for procedural sedation.