Ketamine sedation during air enema reduction of pediatric intussusception: Assessing safety and intraluminal pressure

Abstract

Background: Recent reports have demonstrated promising results regarding the use of ketamine sedation for reducing pediatric intussusception without an associated elevated risk of bowel perforation. However, data on direct intraluminal pressure are still lacking. This study aimed to investigate sedation safety, primarily by comparing intraluminal pressure.

Methods: This retrospective study included patients aged 10 years or younger, diagnosed with intussusception at a university-affiliated pediatric emergency department (ED) between July 2021 and February 2023. These patients were categorized into two groups: sedation and non-sedation. During regular working hours (from 9:00 a.m. to 5:00 p.m. on weekdays), patients were administered 1 mg/kg of intravenous ketamine for sedation during air enema reduction. Patients within non-working hours did not receive sedative interventions.

Results: In a study of 114 patients with intussusception (median age: 25 months), 29 (25.4%) received sedatives, and 85 (74.6%) did not. Maximum intraluminal pressure during the procedure showed no significant difference between the groups (sedation: 64 mmHg, non-sedation: 83 mmHg, p = 0.091). Bowel perforation was not observed in the overall cohort. No difference was observed in the failure rate or recurrence rate within 24 h between the two groups. Sedation with a median dose of 1 mg/kg ketamine did not cause delays in the ED process and demonstrated no adverse events while maintaining appropriate sedation depth with sequential dosing.

Conclusions: The utilization of ketamine sedation during fluoroscopy-guided air enema reduction for pediatric intussusception was not associated with increased intraluminal pressure, increased rate of reduction failure, or bowel perforation.

Keywords: air enema reduction; intussusception; ketamine; procedural sedation.