Background: Ketamine is an anaesthetic agent that has both sedative and analgesic properties. Different routes of administrations of ketamine have been found effective for sedation in children undergoing painful invasive procedures. The oral route is gaining popularity for procedural sedation in children. The objectives of the study were to compare the efficacy and safety of oral ketamine 10mg/kg with 15mg/kg for sedation in paediatric oncology patients undergoing lumbar puncture for chemotherapy.

Methods: This was a double blind randomized study. Children presenting for intrathecal chemotherapy between 1 and 10 years of age were randomly assigned into 2 groups of either 10mg/kg of oral ketamine or 15 mg/kg, each mixed in a 25% glucose solution. Efficacy was assessed by onset time of maximum sedation and success rate of the sedation while safety was assessed by monitoring changes in heart rate, blood pressure and oxygen saturation.

Results: Thirty children (18 with retinoblastoma and 12 with Burkitt lymphoma) were recruited into the study with 15 children assigned into each group. There was no difference in demographic data between the two groups. The mean onset time of maximum sedation was 36.7 ± 3.7 minutes in 15mg/kg compared with 47.1+ 2.8 minutes in the 10mg/kg (p=0.01). Thirteen (86.7%) children were treated with additional IV ketamine in the 10mg/kg group compared with only 3 (20%) in the 15mg/kg group (P= 0.01) in order to achieve the desired sedation. No patient had hypertension or desaturation but tachycardia, nystagmus and hypersalivation were found equally in both groups.

Conclusion: Oral ketamine 15mg/kg is a better sedative than 10 mg/kg in children undergoing lumbar puncture for chemotherapy.

Dr Adigun Tinuola