Does ondansetron have an effect on intramuscular ketamine-associated vomiting in children? A prospective, randomised, open, controlled study.

Abstract

AIM: Ketamine is one of the most commonly used sedatives for facilitating painful

procedures for paediatric patients in the emergency department (ED). However, the

use of ketamine is associated with a common, though not serious, adverse event

usually called ketamine-associated vomiting (KAV). The purpose of this study is

to evaluate the anti-emetic effect of adjunctive ondansetron in paediatric

patients receiving ketamine sedation in the ED. METHODS: We conducted a

prospective, randomised, open, controlled study in children from 1 to 18 years of

age who had undergone intramuscular ketamine sedation in the ED. The patients

were randomised into two groups: a ketamine-only group and a ketamine/ondansetron

group. The patients in the first group received ketamine alone, while those in

the second group received ketamine with oral ondansetron. The incidence of KAV

was estimated in the ED and after discharge, and the time to resumption of a

normal diet was measured after sedation. RESULTS: A total of 237 patients were

analysed. The incidence of KAV was 29.7% in the ketamine-only group and 25.2% in

the ketamine/ondansetron group (P = 0.47). After administration of ketamine, the

mean time to resumption of a normal diet was 8 h 54 min in the ketamine-only

group and 8 h 39 min in the ketamine/ondansetron group (P = 0.67). CONCLUSIONS: A

relatively high rate of KAV (29.7%) was observed, and the time to resumption of a

normal diet after ketamine sedation was rather long. It turned out that, however,

the adjunctive administration of ondansetron did not effectively reduce the

incidence of KAV.