Comparison of intravenous vs. intramuscular ketamine in pediatric procedural sedation

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Background Ketamine is widely used for pediatric procedural sedation in the emergency department (ED). Both intravenous (IV) and intramuscular (IM) administration are effective, but comparative data on efficiency and safety remain limited. Objective To compare the efficiency and safety of IV versus IM ketamine for pediatric procedural sedation in the ED. Methods This retrospective, single-center cohort study included pediatric patients aged 3 months to 17 years who received IV or IM ketamine for procedural sedation in the ED at xxx between September 1, 2022, and August 31, 2024. Patients receiving ketamine for non-procedural purposes were excluded. The primary outcome was time to discharge. Secondary outcomes included time to efficacy, time to recovery, total ED time and adverse events. Results A total of 184 patients were included: 136 received IV ketamine and 48 received IM. Time to discharge was 17 minutes shorter with IV, but not statistically significant (p=0.08). Intravenous ketamine had significantly faster time to efficacy and shorter recovery (p<0.05). No difference was observed in total procedure time or total ED time. Adverse events rates were similar, with most events being mild and cardiovascular in nature. A post-hoc matched analysis by age (±0.5 years) and procedure type showed shorter discharge time with IV (120 vs. 166 minutes; 95% CI –69 to –23; p<0.05), while procedure and ED times remained unchanged. Conclusion Intravenous ketamine provides faster onset and shorter recovery, making it preferable when IV access is available. Intramuscular ketamine remains a viable alternative when IV access is not feasible.

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