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Editorial   |    
The Use of Ketamine Sedation
James D. Heckman, M.D.
J Bone Joint Surg Am, 2000 Jul 01;82(7):911-911
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Fracture reduction is a painful experience that is often very stressful for the patient. This is particularly true for the young child and the child's parents. Thus, orthopaedic surgeons should do everything possible to provide compassionate care, particularly in the hectic and sometimes dehumanizing environment of the typical emergency department. While adequate pain relief (both analgesia and amnesia) should always be the goal of treatment, the safe administration of agents to achieve this objective is of paramount importance.
The paper by McCarty et al. in this issue of The Journal presents one method for achieving effective pain relief during fracture reduction in a defined population of children between the ages of one and eleven years1. While some complications are reported in this series of 114 children, serious problems did not occur. With any type of sedation, deep or otherwise, there is always a risk of airway problems, especially aspiration of gastric contents. This remains true if ketamine is used. Although McCarty et al. use the more benign term "conscious sedation" rather than "general anesthesia" when discussing ketamine, the risks of sedation persist. Regardless of the exact level of sedation, it is essential that properly trained and equipped physicians be responsible for both administration of the drug and monitoring of the patient until the patient has fully recovered from the effects of analgesic or anesthetic agents. The paper by McCarty et al. demonstrates that such a goal can be achieved in the properly staffed and properly equipped emergency department of a level-I trauma center. Heretofore, ketamine has had a varied experience in the anesthetic care of musculoskeletal conditions; the results presented by McCarty et al. should encourage the orthopaedic surgeon to consider its use again, under the right circumstances, in the emergency treatment of selected children's fractures.
James D. Heckman, M.D.
Editor-in-Chief
McCarty, E. C.; Mencio, G. A.; Walker, L. A.; and Green, N. E.: Ketamine sedation for the reduction of children's fractures in the emergency department. J. Bone and Joint Surg.,82-A: 912-918, July 2000.82-A912  2000 
 

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References

McCarty, E. C.; Mencio, G. A.; Walker, L. A.; and Green, N. E.: Ketamine sedation for the reduction of children's fractures in the emergency department. J. Bone and Joint Surg.,82-A: 912-918, July 2000.82-A912  2000 
 
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These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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