Paediatric Ketamine Sedation: Stories from Healthcare Professionals
Neufeld, Michael Todd
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Ketamine provides an efficient and economical way to perform painful procedures without the use of general anaesthesia. The physiological risk profile of ketamine has been thoroughly researched, but the non-physiological implications (specifically 'emergence phenomena') are less well understood. In adult practice these phenomena are acknowledged to be traumatic and, at times, associated with negative outcomes; however, they are often dismissed within paediatric practice. Anecdotally, paediatric emergence phenomena can be a source of worry and concern for healthcare professionals (HCPs). This study sought to explore the perspectives of HCPs on using ketamine sedation when working with children and families. Seven HCPs from the disciplines of medicine, nursing, paramedicine, and play therapy told stories of their experiences with paediatric ketamine sedation. Each HCP had witnessed at least one emergence event from paediatric ketamine sedation. This study provides a narrative hermeneutic analysis of their stories, informed by the works of Frank, Riessman and Charon, with philosophical underpinnings deriving from Heideggerian hermeneutics. The findings are presented in two main themes. The first theme, "seeking to control and protect," reveals the chaos that is an endemic aspect of HCPs' work in the paediatric emergency context. Ketamine is a tool that helps HCPs to gain control over the chaos associated with the physiological aspects of children's responses to pain and fear. However, ketamine can also create chaos in the form of emergence phenomena. HCPs view children as vulnerable and warranting extra protection, and yet they acknowledge that they frequently use ketamine sedation as much for themselves as for the children they are treating, thus revealing an inherent moral tension. The second theme, "working in the dark," acknowledges that to truly 'protect' children, HCPS must understand risk and harm. HCPs measure the risks of paediatric ketamine sedation physiologically but also worry about potential non-physiological risks, having witnessed children's fear and terror as they emerge from sedation. As HCPs work to balance benefit and harm, they acknowledge their limited ability to fully 'know' ketamine sedation. This is due, in part, to a lack of research into children's lived experiences and the tendency to dismiss paediatric emergence phenomena. HCPs therefore defer to a collective knowledge to guide their practice and use dream-seeding, despite lack of research evidence, to try to protect children from negative emergence phenomena. This study recommends further research into children's experiences of ketamine sedation and emergence phenomena (inclusive of dream-seeding). It also proposes education of clinicians to increase awareness of non-physiological risk and harm.