Intranasal ketamine analgesia

March 25, 2011 by  
Filed under All Updates, EMS, Kids, Resus, Trauma

I published a case report in the EMJ highlighting the use of intranasal ketamine in a pre-hospital paediatric burns case.

The lad had nasty scalds but did not need iv fluids and had no other indications for an iv line. The vigorous first aid had rendered him cold and veinless and an intraosseous would have been overkill. Ketamine was perfect for the job and Ambulance Service New South Wales paramedics carry a mucosal atomisation device (MAD) for the administration of i.n. fentanyl. I used the MAD to adminster 0.5 mg/kg ketamine, but there is a dead space in the device (0.1 ml) that probably resulted in actual delivery of 0.25mg/kg. This gave great analgesia and compliance enabling us to painlessly apply polyethylene film to the burns.

I received the following email from TIm Wolfe, the inventor of the MAD nasal (reproduced with permission):


Nice contribution to the literature. There is a lot of interest in IN ketamine in these lower doses to treat pain but not cause sedation. You eluded to the military interest and the hospice interest. I think your insights for EMS are also cutting edge – hopefully this will lead others to design a larger trial.


Tim Wolfe, MD

More information on the use of intranasal medication is available at I have no conflicts of interest to declare.

Case report: prehospital use of intranasal ketamine for paediatric burn injury
Emerg Med J. 2011 Feb 3. [Epub ahead of print]


One Response to “Intranasal ketamine analgesia”

  1. The LITFL Review 012 - Life in the FastLane Medical Blog on March 28th, 2011 01:33

    […] auto-reviews his case in the EMJ demonstrating the¬†effectiveness of¬†Intranasal ketamine analgesia in a child with […]