To address the common belief that ketamine increases intraocular pressure, researchers prospectively evaluated the effect of intravenous ketamine on intraocular pressure in previously healthy children ages 1 to15 years who underwent procedural sedation for nonocular complaints at a tertiary care pediatric emergency department. Intraocular pressure was measured with a Tono-Pen XL tonometer immediately after and 2.5, 5, and 10 minutes after ketamine administration. A pressure difference of at least 15% was considered clinically relevant.
Over 16 months, 80 children were enrolled and received a mean ketamine does of 1.6 mg/kg. No clinically relevant difference was found between mean intraocular pressure immediately after and 2.5 minutes after ketamine administration (17.5 mm Hg and 18.9 mm Hg). Analysis of variance between age groups (1–5, 6–10, and 11–15 years) revealed a nonclinically relevant but statistically significant increase in intraocular pressure over the entire 10-minute study period (changes <2.5 mm Hg).
Comment: These authors provide convincing evidence that ketamine does not increase intraocular pressure at doses used for procedural sedation. It is unlikely that the result would differ substantially in children with ocular complaints. When ketamine is the best choice for pediatric sedation, providers can use it without fear of iatrogenic ocular damage.
Source: Journal Watch Emergency Medicine