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Use of ketamine by paediatricians in Italian paediatric emergency departments: a missed opportunity?

  • Alberto Di Mascio
  • Benedetta BossiniEmail author
  • Egidio Barbi
  • Franca Benini
  • Giorgio Cozzi
Short Communication

Abstract

Procedural sedation and analgesia with ketamine are part of daily practice for children undergoing painful procedures in the paediatric emergency department (ED) of North America. A massive number of studies demonstrate ketamine’s safety and efficacy in the hands of trained ED paediatricians, with few severe adverse events (SAEs) recorded. Since there are no data on ketamine’s usage in Italian paediatric EDs, we created a survey to examine procedural sedation with ketamine in the EDs of the Italian PIPER (Pain in Paediatric Emergency Room) group, which includes 36 paediatric EDs providing 1.4 million paediatric visits each year. Results were reviewed using frequencies to describe responses. Thirty-two out of 36 centres replied to the questionnaire. In 6 (19%) out of 32 centres, ketamine is not used at all in the paediatric ED. In 6 centres (23%) of 26 which use ketamine, this drug is autonomously administered by the emergency paediatrician, whereas in 20 (77%) of them it is exclusively managed by the anaesthesiologist on call.

Conclusion: ketamine is autonomously administered only by a small percentage of Italian emergency paediatricians. There is an increasing need for implementation of procedural sedation training and use of ketamine in the everyday practice outside the operating room in paediatric EDs.

What is Known:

Ketamine is safely and efficaciously administered for children’s procedural sedation and analgesia by trained emergency paediatricians in the everyday practice outside the operating room in North America.

In the Italian setting, there are no data at all concerning ketamine’s usage by the emergency paediatricians for procedural sedation and pain control.

What is New:

In this study emerged that ketamine is poorly administered by Italian emergency paediatricians for procedural sedation and analgesia outside the operating room.

A great deal of educational effort should be made to widen ketamine based procedural sedation availability in Italian emergency departments by spreading specific training tracks and guidelines.

Keywords

Ketamine Procedural sedation Emergency department Analgesia Children Child 

Abbreviations

BP

Blood pressure

ED(s)

Emergency department(s)

ET-CO2

End-tidal CO2

HR

Heart rate

IM

Intramuscular

IN

Intranasal

IV

Intravenous

PIPER

Pain in Paediatric Emergency Room

RR

Respiratory rate

SAE(s)

Severe adverse event(s)

SIMEU

Italian Society of Emergency Physicians

SpO2

Oxygen’s saturation

Notes

Acknowledgements

We would like to thank all the PIPER (Pain in Paediatric Emergency Room) group members who participated to the study:

T. Zangardi (Azienda Ospedaliera Universitaria, Padova); F. Marzona (Azienda Ospedaliera Universitaria, Udine); E. Barbi (Istituto Materno Infantile Burlo Garofolo, IRCCS, Trieste); D. Silvagni (Azienda Ospedaliera Universitaria Integrata, Verona); A. Arrighini (Azienda Ospedaliera Spedali Civili P.O. dei Bambini, Brescia); C. Scalfaro (Azienda Ospedaliera S. Carlo Borromeo, Milano); S. Fontanazza (Istituto Giannina Gaslini, IRCCS, Genova); L. Calistri (Azienda Ospedaliera Universitaria Meyer, Firenze); E. Fabiani (Azienda Ospedaliera Universitaria Salesi, Ancona); C. Tomasello (Ospedale Pediatrico Bambino Gesù, Roma); A. Chiaretti (Policlinico Agostino Gemelli, Roma); S. Barca (Azienda Ospedaliera di Como, Como); M. Bonora (Presidio Ospedaliero “Madonna delle Grazie”, Matera); M.R. Govoni (Azienda Ospedaliera Arcispedale Sant’Anna, Ferrara); R. Petrino (Ospedale Sant’Andrea, Vercelli); F. Borrometi (Azienda Ospedaliera Santobono Pausilipon, Napoli); R. Parrino (Presidio dell’ARNAS “Civico di Cristina–Benefratelli”, Palermo); A. Tornesello (Presidio Ospedaliero Vito Fazzi, Lecce); S. Faragò (Azienda Ospedaliera Puglieseciaccio, Catanzaro); F. Ferrero (Azienda Ospedaliera Universitaria Maggiore della Carità, Novara); A. Cella (Ospedale Guglielmo da Saliceto, Piacenza); P. Manfredi (Presidio Ospedaliero Vaio Fidenza, Parma); F. Midulla (Sapienza Università di Roma Deap Clinica Pediatrica, Roma); M. Taglietto (Città della Salute e della Scienza di Torino presidio OIRM, Torino); A. Tonetto (Presidio Ospedaliero San Donà di Piave, Venezia); S. Pusceddu (AUSL Romagna, Ravenna); M. Fantinato (Ospedale San Bortolo, Vicenza); C. Vezzoli (Spedali Cividi di Brescia, Brescia); S. Cherubini (Presidio Ospedaliero di Busto Arsizio, Varese); A. Sfacello (Ospedale Maggiore di Chieri, Torino); G. Molinaro (Azienda Ospedaliera dell’Alto Adige, Bolzano); L. Dell’Era (Clinica De Marchi Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano).

We would also like to thank the following revisors:

Steven M. Green, Piet L.J.M. Leroy, Mark G. Roback, Gary Andolfatto

Authors’ Contributions

Benedetta Bossini and Alberto Di Mascio wrote the first draft of this work, and no funding was received to write it. Each author (Alberto Di Mascio, Benedetta Bossini, Egidio Barbi, Franca Benini, Giorgio Cozzi) approves the submission of this version of the manuscript and takes full responsibility for it. Egidio Barbi, Franca Benini and Giorgio Cozzi reviewed the work.

Compliance with ethical statements

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The study did not involve any collection or analysis of personal data regarding human participants but only hospitals and policies, according to Italian law requirements for informed consent, and approval by Ethics Committee was not applied. In Italy ethical review is mandatory only for clinical trials on pharmaceutical products ( http://www.agenziafarmaco.gov.it/sites/default/files/Decreto_Legislativo_n._211_del_24_giugno_2003.pdf ) and for observational studies on use of drugs by human participants ( http://www.agenziafarmaco.gov.it/sites/default/files/det_20marzo2008.pdf ).

Statement of informed consent

Each centres gave its informed consent to participate in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alberto Di Mascio
    • 1
  • Benedetta Bossini
    • 1
    Email author
  • Egidio Barbi
    • 1
    • 2
  • Franca Benini
    • 3
  • Giorgio Cozzi
    • 2
  1. 1.Department of Medicine, Surgery and Health SciencesUniversity of TriesteTriesteItaly
  2. 2.Department of PediatricsInstitute for Maternal and Child Health–IRCCS ‘Burlo Garofolo’TriesteItaly
  3. 3.Paediatric Pain and Palliative Care Service, Department of Woman and Child HealthUniversity of PaduaPaduaItaly

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