c. Complete the following table regarding ketamine usage in paediatric procedural sedation by route of delivery (8 Marks) Intra-muscular (i.m) (i.v) Initial dose Top-up dose Advantage Disadvantage Answers a. List 8 contraindications to ketamine use in this setting ? (4 Marks) 1/2 mark each up to 4 marks from the following: Parental refusal Procedural required unsuitable for ketamine sedation Inadequate staffing / area / equipment Previous adverse reaction to Ketamine Altered conscious state Unstable patient: seizures, vomiting, hypotension Cardiovascular disease - failure, uncontrolled hypertension, congenital heart disease Procedures involving stimulation of posterior pharynx Known airway instability or tracheal abnormality Psychosis Thyroid disorder or medication Porphyria Risk of raised intraocular or intracranial pressure Active pulmonary infection or disease including acute asthma and URTI Full meal within 3 hours (relative contraindication only, balance risk against urgency of procedure) b. List 4 potential side effects/complications associated with ketamine use in this setting (2 1/2 mark each up to 2 marks from the following: Airway obstruction Nystagmus Muscle rigidity Random movements (can resemble seizure like activity) Vomiting (during or procedure) Emergence phenomena Apnoea Failed procedure (need for a General Anaesthesia) Hypersalivation
c. Complete the following table regarding ketamine usage in paediatric procedural sedation by route of delivery (8 Marks) Intra-muscular (i.m) (i.v) Initial dose Top-up dose Advantage Disadvantage Answers a. List 8 contraindications to ketamine use in this setting ? (4 Marks) 1/2 mark each up to 4 marks from the following: Parental refusal Procedural required unsuitable for ketamine sedation Inadequate staffing / area / equipment Previous adverse reaction to Ketamine Altered conscious state Unstable patient: seizures, vomiting, hypotension Cardiovascular disease - failure, uncontrolled hypertension, congenital heart disease Procedures involving stimulation of posterior pharynx Known airway instability or tracheal abnormality Psychosis Thyroid disorder or medication Porphyria Risk of raised intraocular or intracranial pressure Active pulmonary infection or disease including acute asthma and URTI Full meal within 3 hours (relative contraindication only, balance risk against urgency of procedure) b. List 4 potential side effects/complications associated with ketamine use in this setting (2 1/2 mark each up to 2 marks from the following: Airway obstruction Nystagmus Muscle rigidity Random movements (can resemble seizure like activity) Vomiting (during or procedure) Emergence phenomena Apnoea Failed procedure (need for a General Anaesthesia) Hypersalivation
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