Hemodynamic effects of ketamine in children with congenital heart disease and/or pulmonary hypertension

Introduction: Ketamine is a drug often used for procedural sedation or as adjunct agent for general sedation in children with congenital heart disease. In the clinical realm, there is often confusion regarding the effects of ketamine on hemodynamics, particularly pulmonary vascular resistance and systemic vascular resistance. We performed a meta-analysis of studies investigating the effects of ketamine on hemodynamics.

Methods: A systematic review was conducted to identify studies characterizing the hemodynamic effects of ketamine in children with congenital heart disease. Studies were assessed for quality and those of satisfactory quality with pre- and postketamine hemodynamics for each patient were included in the final analyses. Those not limited to pediatric patients and those not limited to patients with congenital heart disease were excluded from the final analyses.

Results: A total of 7 studies with 139 patients were included in the final analyses. Pulmonary vascular resistance, systemic vascular resistance, mean pulmonary artery pressure, mean systemic pressure, heart rate, pH, and arterial oxygen concentration did not significantly change with administration of ketamine. Carbon dioxide concentration did increase significantly by a mean of 1.38 mm Hg with the administration of ketamine.

Conclusion: Ketamine has minimal impact on hemodynamics in children with congenital heart disease when used at usual clinical doses. Systemic vascular resistance and pulmonary vascular resistance are not significantly altered. Blood gas values are also only minimally affected by ketamine.