Anesthesia Management: Intraocular Pressure Increases Are Trivial in Children During Ketamine Sedation

Authors: Wadia S et al., Ann Emerg Med 2014 Oct 64:385

In a study of 60 children undergoing procedural sedation with ketamine, intraocular pressure increased only by a median of 3 mm Hg.

Investigators evaluated ketamine’s effect on intraocular pressure in a prospective observational study of children aged 8–18 years undergoing procedural sedation at a pediatric emergency department. Tono-Pen measurements were taken before ketamine administration, immediately after, 2 minutes after, and every 5 minutes thereafter for up to 30 minutes. Children with a predisposition to elevations in intraocular pressure (e.g., diabetes mellitus, steroid use, history of previous eye surgery) were excluded.

Of 60 children who received ketamine (median cumulative dose, 1.5 mg/kg), the median increase in intraocular pressure was 3 mm Hg. Fifteen children (25%) had increases greater than 5 mm Hg (the predefined threshold for a potentially clinically important increase), which resolved by 15 minutes in all but three. There were no differences in clinical characteristics between children with and without pressure increases greater than 5 mm Hg. Mean highest absolute pressure was 19 mm Hg (range, 14–25 mm Hg).

Comment

This is consistent with a previous study showing that ketamine caused no significant increase in intraocular pressure (NEJM JW Emerg Med Nov 9 2012). The authors’ cautions about ketamine use in patients with ocular pathology substantially overstate their own findings. To the contrary, this study reassures us that ketamine need not be avoided for concern about raising intraocular pressure.