Ketamine/Midazolam Sedation by Interventional Radiologists Enables Pediatric Procedures Without Anesthesiology Support

Purpose: Performing procedures on children usually requires anesthesiology. Ketamine sedation is an emerging practice in interventional radiology (IR) with favorable outcomes in adults. This study reports outcomes in children undergoing image-guided procedures using ketamine sedation without anesthesiology.

Materials and Methods: All IR procedures in patients < 18 years using intravenous ketamine/midazolam without anesthesiology were identified in the Picture Archiving and Communication System. Demographics, procedural details, medications, and intra-procedural vital signs were gleaned from medical charts. Data are presented descriptively as median (range).

Results: Ten procedures were performed in 9 children (5 girls, 4 boys), 13 (10–17) years old; weighing 54 (40–92) kg. No child had sleep apnea or opiate dependence history. Procedures included 7 abdominopelvic drainages, 1 intrapulmonary drainage, and 1 liver and 1 renal biopsy, performed with US (3) or CT (7). Sedation included 2 (0–2) mg midazolam and 50 (40–50) mg ketamine, corresponding to 0.9 (0.5–1.2) mg/kg ketamine. Nine cases were completed using room air and 1 with nasal cannula; lowest oxygen saturation was 98 (93–100) %. No sedation-related or respiratory adverse events occurred. Minimum and maximum systolic blood pressure was 109 (99–140) and 131 (118–148) mmHg. Antiemetics were given in 4 (40%) procedures. Median post-procedure day 1 opioid use was 2 (0–26.5) mg (morphine milligram equivalent). All procedures were completed successfully and tolerated by the children. No post-procedure adverse events occurred; 1 patient presented the next day with back pain after biopsy and was discharged after analgesia.

Conclusion: Ketamine/midazolam sedation administered by IRs allowed invasive procedures such as abscess drainage and solid organ biopsy to be completed successfully without the need for anesthesiology support. Incorporating ketamine sedation into an IR department may facilitate efficient care for children who need image-guided procedures.