Study Highlights. Changes since the 2004 guidelines include the following:
- The updated guidelines now support expansion of ketamine use to children aged 3 to 12 months, which is younger than previously recommended, as well as to adults.
- Minor oropharyngeal procedures and head trauma are no longer contraindications to ketamine use.
- Emergency medicine physicians should administer ketamine intravenously instead of intramuscularly whenever feasible because recovery is faster and there is less emesis.
- Routine use of prophylactic anticholinergic medications is no longer recommended.
- Routine use of prophylactic benzodiazepines is not recommended for children but may be helpful in adults (eg, midazolam 0.03 mg/kg intravenously; number needed to benefit = 6).
- Prophylactic use of ondansetron may slightly reduce vomiting (number needed to benefit ≥ 9)