Efficacy of ketamine in pediatric sedoanalgesia for orotracheal intubation: a systematic review

OBJECTIVE: To compare the efficacy and effects of ketamine administration with other drugs for sedoanalgesia during orotracheal intubation in hospitalized pediatric patients. METHOD: A systematic review in English and Portuguese was conducted using the PUBMED/MEDLINE and LILACS databases. The descriptors “Ketamine” AND “Fentanyl” AND “Propofol” AND “Midazolam” AND “Children” were used. After applying the inclusion and exclusion criteria, 114 articles were initially selected for analysis, resulting in the inclusion of 11 articles for data extraction. RESULTS: The study included 7,868 individuals aged 0 to 18 years. Intranasal ketamine administration was found to be an excellent alternative in cases where opioid use is contraindicated. When compared with sevoflurane for agitation prevention, sevoflurane was found to be unsafe, whereas the combination of intranasal ketamine with midazolam showed better effects on anesthetic induction and recovery. Additionally, one study revealed that the combination of ketamine with fentanyl increased blood pressure and relative risk up to 30 minutes after laryngeal mask insertion, although it provided more stable hemodynamic parameters and advantageous effects on patient recovery. CONCLUSION: The efficacy of ketamine may vary depending on the route of administration and dosage used, with the nebulized form at doses between 1.5 mg/kg and 2 mg/kg demonstrating the greatest efficacy. Thus, ketamine is an effective, safe, and versatile option for orotracheal intubation in pediatric patients, representing a viable non-opioid alternative with a favorable safety profile.