Ketamine is not a safe, effective, and appropriate technique for emergency department paediatric procedural sedation

Definitive studies are needed In the United Kingdom, there is very little formal competency based training in the techniques of paediatric procedural sedation except in the specialty of dentistry.1,2 Procedural sedation is often delegated to junior medical staff using a local protocol. The procedures for informed consent, documentation, monitoring, recovery, follow up, and audit are varied and often non-existent. This situation is changing as new clinical governance and training systems are put in place. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) has produced a multidisciplinary, evidence based, peer reviewed guideline for the management of paediatric procedural sedation.3 The consensus view of this group was that, in Scotland, ketamine (and agents such as propofol, fentanyl, alfentanil, and remifentanil) should only be used by those trained in and with adequate on-going experience of paediatric anaesthesia and/or intensive care. It should only be used in a hospital …