Int J Clin Pediatr

International Journal of Clinical Pediatrics, ISSN 1927-1255 print, 1927-1263 online, Open Access

Article copyright, the authors; Journal compilation copyright, Int J Clin Pediatr and Elmer Press Inc

Journal website https://ijcp.elmerpub.com

Original Article

Volume 15, Number 2, June 2026, pages 62-68

Efficacy and Safety of Ketamine Infusions in Pediatric Patients With Acute Pain Related to Sickle Cell Disease

↓ Figure 1. Flow diagram of patient identification and inclusion of hospitalizations in the retrospective cohort evaluating ketamine infusions for sickle cell disease-related pain.

↓ Figure 2. Distribution of ketamine infusion rate (left) and infusion duration (right) by occurrence of adverse events. P-values from linear mixed-effects models indicate no significant association.

↓ **Table 1.** Ketamine Policy and Protocol for Ketamine Infusions Outside of the ICU Setting
Category	Protocol details
BP: blood pressure; HR: heart rate; ICU: intensive care unit; RR: respiratory rate.
Implementation	Institutional policy developed in 2014
Location of administration	Hematology/oncology and other inpatient wards (non-ICU)
Indication	Opioid-refractory pain
Ordering provider	Acute pain or palliative care attending
Starting dose	0.025–0.1 mg/kg/h
Maximum dose	0.4 mg/kg/h
Monitoring	Continuous pulse oximetry; BP, HR, RR; sedation level; mental status or level of consciousness; pain score
Nursing preparation	Required training and competency testing prior to implementation

↓ Table 1. Ketamine Policy and Protocol for Ketamine Infusions Outside of the ICU Setting

Category

Protocol details

BP: blood pressure; HR: heart rate; ICU: intensive care unit; RR: respiratory rate.

Implementation

Institutional policy developed in 2014

Location of administration

Hematology/oncology and other inpatient wards (non-ICU)

Indication

Opioid-refractory pain

Ordering provider

Acute pain or palliative care attending

Starting dose

0.025–0.1 mg/kg/h

Maximum dose

0.4 mg/kg/h

Monitoring

Continuous pulse oximetry; BP, HR, RR; sedation level; mental status or level of consciousness; pain score

Nursing preparation

Required training and competency testing prior to implementation

↓ **Table 2.** Demographic Characteristics of the Study Population
Characteristic	Patients (n = 51)	Hospitalizations (n = 141)
Continuous variables are presented as mean ± standard deviation or median (IQR), and categorical variables as n (%). ^aAge at first admission per patient. IQR: interquartile range.
Demographic data
Age at admission, years	17 (14–19)^a	18 (15–19)
Female gender, n (%)	26 (51)
Non-Hispanic Black, n (%)	51 (100)
Hospitalization characteristics
Number of hospitalizations per patient, median (IQR)	2 (1–5)
Length of stay, days, median (IQR)		10 (7–16)
Ketamine infusion characteristics
Starting infusion rate, mg/kg/h, mean ± SD		0.10 ± 0.03
Average daily infusion rate, mg/kg/h, mean ± SD		0.10 ± 0.04
Infusion duration, days, median (IQR)		4 (2–7)
Adverse events
Any adverse event, n (%)	24 (47.1)	33 (23.4)
Infusion stopped due to adverse event, n (%)	12 (23.5)	18 (12.8)
Infusion stopped due to ineffectiveness, n (%)	7 (13.7)	8 (5.7)

↓ Table 2. Demographic Characteristics of the Study Population

Characteristic

Patients (n = 51)

Hospitalizations (n = 141)

Continuous variables are presented as mean ± standard deviation or median (IQR), and categorical variables as n (%). ^aAge at first admission per patient. IQR: interquartile range.

Demographic data

Age at admission, years

17 (14–19)^a

18 (15–19)

Female gender, n (%)

26 (51)

Non-Hispanic Black, n (%)

51 (100)

Hospitalization characteristics

Number of hospitalizations per patient, median (IQR)

2 (1–5)

Length of stay, days, median (IQR)

10 (7–16)

Ketamine infusion characteristics

Starting infusion rate, mg/kg/h, mean ± SD

0.10 ± 0.03

Average daily infusion rate, mg/kg/h, mean ± SD

0.10 ± 0.04

Infusion duration, days, median (IQR)

4 (2–7)

Adverse events

Any adverse event, n (%)

24 (47.1)

33 (23.4)

Infusion stopped due to adverse event, n (%)

12 (23.5)

18 (12.8)

Infusion stopped due to ineffectiveness, n (%)

7 (13.7)

8 (5.7)

↓ **Table 3.** Adverse Events by Hospitalization and Patient
Adverse events	Hospitalizations with adverse effect (n)	Patients with adverse effect (n)
Data represent the number of hospitalizations and the number of patients experiencing each adverse event; some hospitalizations included multiple events. n: number of observations.
Hallucinations	10	9
Dizziness	10	10
Delirium	5	5
Nausea	4	4
Agitation	3	3
Sedation	3	3
Pruritus	3	3
Blurry vision	3	3

↓ Table 3. Adverse Events by Hospitalization and Patient

Adverse events

Hospitalizations with adverse effect (n)

Patients with adverse effect (n)

Data represent the number of hospitalizations and the number of patients experiencing each adverse event; some hospitalizations included multiple events. n: number of observations.

Hallucinations

Dizziness

Delirium

Nausea

Agitation

Sedation

Pruritus

Blurry vision