A Comparison Study of Two Different Methods of Administration: Intranasal versus Intramuscular for Pediatric Procedural Sedation and Analgesia

Abstract

Purpose: To compare the efficacy of ketamine between intranasal (IN) administration and intramuscular (IM) injection for pediatric procedural sedation and analgesia (PPSA). Methods: A prospective study was conducted during 3 months. Ketamine was given by IN or IM route before primary repair of facial laceration for procedural sedation. The administration dose was 8 mg/kg for IN and 4 mg/kg for IM. We evaluated resistance scale on administration, sedation scale, satisfaction of physician and parents. Results: One hundred children were enrolled into this study. IN administration was given to 50 children, and IM injection to 50 children each. In the IN group, 75%(36 of 50) showed severe resistance, whereas only 34%(17 of 50) showed severe resistance and 50%(25 of 50) showed mild resistance in IM group. Successful rate of sedation after initial administration was 82%(41 of 50) in IM group and 34% in IN group. Satisfaction of physicians and parents was high in IM injection group. Conclusion: Intranasal administration of Ketamine is less effective and provides lower satisfaction than intramuscular injection for procedural sedation of pediatric patients in the emergency department.