Seyedhossein Seyedhosseini Davarani - Tehran university of medical sciences, Tehran, Iran
Hamideh Akbari - Tehran university of medical sciences, Tehran, Iran
Ahmad Ghatte - Tehran University of Medical Sciences
Sepideh Babaniamansour - School of Medicine, Islamic Azad University Tehran Faculty of Medicine, Tehran, Iran
Ehsan Aliniagerdroudbari - School of Medicine, Islamic Azad University Tehran Faculty of Medicine, Tehran, Iran
Ehsan Karimia lavijeh - Tehran university of medical sciences, Tehran, Iran

Background and Aim : Background: the prevalence of hypoventilation is higher in theintramuscular (IM) administration of Ketamine in pediatric patients. Although Capnographydetects hypoventilation quickly, in a resource-limited ED it is important to evaluate Its costeffectiveness.Aims: To find out if other vital signs can detect changes in ETCO2 during theProcedural sedation and analgesia (PSA) and whether capnography is mandatory during the PSAwith ketamine.Methods : Methods: This was a cross-sectional study conducted in 2015. Pediatric patients (agedunder 14) who underwent PSA by ketamine 5mg/kg IM were included. ETCO2 was monitored bythe sidestream CO2 sensor. Hypoventilation was defined as ETCO2 variation greater than 10 mmHg from baseline. Researchers continuously monitored the patients and recorded ETCO2, SPO2,Pulse rate (PR), respiratory rate (RR), and Blood pressure (BP). The specificity and sensitivity ofPR, BP, RR, and SPO2 for detecting 10mmhg change in the ETCO2 level was calculated.Results : Results: One hundred twenty-one patients were enrolled in the study. The mean ± SDage was 2.89 ± 1.48. 19(15.7%) patients had over ten mmHg changes in the ETCO2 level. Amongvital signs, PR and RR had a significant association with respiratory depression ( p-value = 0.011,and 0.005, respectively). Vital signs were not accurate to detect ETCO2 changes, and the highestAUC was 0.6.Conclusion : Considering the prevalence of hypoventilation among Pediatric patients, it seemsthat capnography is a piece of the necessary equipment in Ketamine PSA.

ketamine; Capnography; Analgesia; Pain management; Hypoventilation; Conscious Sedation; pediatrics