Systematic ReviewResearchMedication Safety

Emergency pediatric ketamine sedation showed exceptional airway safety in review of 58,752 children

Annals of Emergency Medicine (PubMed)Oct 1, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review of 20 studies analyzing 58,752 children undergoing emergency department intravenous ketamine procedural sedation found zero deaths or permanent neurological deficits, with sentinel airway adverse events occurring in only 1 out of 24,390 sedations.

What NurseJet pulled from the source

Examining 58,752 pediatric sedation encounters, sentinel events (including tracheal intubation, aspiration, and chest compressions) occurred in just 0.0041% of cases (95% CI 0.0010%-0.016%). Serious events occurred in 0.33%, with modest risks linked to age 10 or older (1 in 106), active upper respiratory infection (1 in 114), and coadministered opioids (1 in 161), whereas benzodiazepine coadministration did not predict adverse events.

Why this matters for nurses

Emergency and pediatric nurses continuously monitor pediatric airway patency, capnography, and vital signs during procedural sedation. These findings reaffirm the excellent safety profile of intravenous ketamine while highlighting that older children, active respiratory tract infections, and concurrent opioids warrant heightened airway vigilance.

Bedside takeaway

IV ketamine in 58,752 pediatric ED sedations caused zero deaths and only 1 sentinel airway event per 24,390 encounters, with opioids and active URI identified as modest risk factors.

Key takeaways

Across 58,752 children, zero deaths or permanent neurological injuries were reported during intravenous ketamine procedural sedation.
Sentinel airway and cardiovascular complications occurred in only 0.0041% of encounters (approximately 1 per 24,390 patients).
Serious adverse events occurred in 0.33% of encounters, with modest increases observed in children aged >= 10, those with upper respiratory infections, and when opioids were coadministered.
Neither ASA physical status classification nor coadministered benzodiazepines significantly predicted serious adverse events.

Practice implications

Maintain continuous capnography, pulse oximetry, and suction readiness for all pediatric ketamine sedations. Perform focused pre-sedation screenings for current upper respiratory symptoms and recent opioid administration, and maintain rescue airway supplies (bag-valve-mask, appropriate oral/nasal airways) immediately at the bedside.

Limitations & cautions

The review compiled 20 observational studies with varying definitions of minor adverse events and excluded studies with fewer than 250 patients. Variations in ketamine dosing intervals and procedural indications across emergency departments were present.
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Annals of Emergency Medicine (PubMed)

Annals of Emergency Medicine (PubMed). Systematic Review of Pediatric Ketamine in Emergency Department Procedural Sedation: Frequency and Predictors of Adverse Events.

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https://pubmed.ncbi.nlm.nih.gov/42138678/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Neurosurgical review (PubMed)Oct 17, 2026Systematic Review

A systematic review and meta-analysis of 14 studies comprising 7,981 patients found extending single-agent antibiotic prophylaxis beyond one day did not reduce postoperative meningitis after endoscopic endonasal skull base surgery, whereas intraoperative CSF leak significantly increased infection risk.

Med-SurgAI summaryReview source

Systematic ReviewResearchInfection ControlMedication SafetyAI summary · original source linked below

Postoperative meningitis is an uncommon but severe complication following endoscopic endonasal skull base surgery (EESBS). While perioperative antimicrobial prophylaxis is universally administered, the required duration remains controversial, frequently leading to prolonged, non-evidence-based antibiotic courses. Following PRISMA guidelines, researchers meta-analyzed 14 studies covering 7,981 patients receiving single-agent antibiotic prophylaxis categorized as ultra-short (≤1 day), short (1–3 days), or long (>3 days). The pooled incidence of postoperative meningitis across all cohorts was 1.38% (95% CI: 0.92%–2.08%; I² = 65.8%). Subgroup analysis showed comparable meningitis rates across duration cohorts: 1.24% for ultra-short prophylaxis (95% CI: 0.66%–2.32%), 1.20% for short prophylaxis (95% CI: 0.38%–3.70%), and 2.12% for long prophylaxis (95% CI: 0.82%–5.36%), with no statistically significant difference (p = 0.764). Meta-regression confirmed prophylaxis duration was not associated with meningitis (p = 0.487). Instead, higher study-level prevalence of intraoperative cerebrospinal fluid (CSF) leakage was significantly associated with increased meningitis rates (β = 0.0389 per percentage point; p = 0.010).

Key takeaways

Meta-analysis evaluated 14 studies including 7,981 patients undergoing endoscopic endonasal skull base surgery.
Overall postoperative meningitis incidence was 1.38% (95% CI: 0.92%–2.08%).
Meningitis rates did not differ between ultra-short ≤1 day (1.24%), short 1–3 days (1.20%), or long >3 days (2.12%) antibiotic regimens (p = 0.764).
Intraoperative CSF leakage was a significant driver of postoperative meningitis (p = 0.010), while prolonged antibiotic coverage conferred no protective benefit.

Why this matters on shift

Infection preventionists and perioperative surgical nurses champion antimicrobial stewardship by stopping surgical prophylaxis within 24 hours post-procedure. This large-scale evidence confirms that extending prophylactic antibiotics beyond 24 hours does not prevent central nervous system infections in skull base surgery and reinforces focusing post-op surveillance on intraoperative CSF leak status rather than extended antibiotic exposure.

Bedside takeaway

In 7,981 skull base surgeries, postoperative meningitis incidence was 1.38% and did not differ between ≤1 day (1.24%) and >3 days (2.12%) of antibiotics, while CSF leak was the primary infection risk.

Nursing implications

Support timely discontinuation of perioperative antibiotics within 24 hours post-op in accordance with national surgical infection prevention guidelines, maintain high clinical vigilance for signs of CSF rhinorrhea, headache, nuchal rigidity, and fever, and ensure rapid diagnostic escalation if CSF drainage is suspected.

Limitations & cautions

Included cohorts were retrospective observational studies with moderate heterogeneity (I² = 65.8%); specific antibiotic choices and dosing regimens varied across surgical centers.
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Citations · exact source links

Neurosurgical review (PubMed). Duration of single-agent perioperative antibiotic prophylaxis and postoperative meningitis after endoscopic endonasal skull base surgery: a systematic review and meta-analysis of 7,981 patients.

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Trauma, violence & abuse (PubMed)Oct 17, 2026Systematic Review

A systematic review and meta-analysis of 20 emergency department studies encompassing 7,498 women found intimate partner violence was associated with a three-fold increased risk of suicide attempt, with psychological violence showing a stronger association than physical violence.

Emergency PsychAI summaryReview source

Systematic ReviewResearchWorkflowQuality ImprovementAI summary · original source linked below

Women experiencing intimate partner violence (IPV) and acute suicidality frequently seek medical evaluation in emergency departments (EDs), but the intersection between these two acute presentations is often overlooked during fast-paced triage. This systematic review, meta-analysis, and narrative synthesis synthesized 20 ED-based studies comprising 7,498 women across three global databases. Investigators used random-effects models and evaluated study quality with the Joanna Briggs Institute (JBI) checklist. Overall, 22% (95% CI: 11%–36%) of women presenting to the ED for suicide-related care had a history of physical IPV, while 13% (95% CI: 8%–18%) of women with known IPV histories reported active suicidality. A history of IPV was associated with a three-fold increase in the risk of suicide attempt (risk ratio [RR] 3.00; 95% CI: 1.39–6.47). Notably, psychological IPV demonstrated a stronger association with suicide risk (RR 3.23; 95% CI: 1.68–6.19) than physical IPV alone (RR 2.00; 95% CI: 1.26–3.17).

Key takeaways

Systematic review synthesized 20 emergency department studies encompassing 7,498 women.
Nearly 1 in 4 women (22%; 95% CI: 11%–36%) presenting to the ED with suicidality had experienced physical IPV.
IPV was associated with a three-fold higher risk of suicide attempt (RR 3.00; 95% CI: 1.39–6.47).
Psychological IPV showed a higher risk ratio for suicide attempts (RR 3.23; 95% CI: 1.68–6.19) than physical IPV (RR 2.00; 95% CI: 1.26–3.17).

Why this matters on shift

Emergency nurses are the primary healthcare professionals conducting universal triage, suicide risk screening (e.g., C-SSRS), and domestic violence assessments. Recognizing that nearly one-quarter of suicidal female presentations co-occur with IPV—and that non-physical, psychological abuse carries an even higher relative risk for suicide attempt—demands that ED nursing assessments integrate trauma-informed safety planning rather than treating suicidality and relationship violence in isolation.

Bedside takeaway

In an ED meta-analysis of 7,498 women, intimate partner violence tripled suicide attempt risk (RR 3.00), with psychological IPV (RR 3.23) linked more strongly than physical IPV (RR 2.00).

Nursing implications

Conduct routine IPV and suicide screenings privately away from companions or visitors, assess for emotional and psychological coercion even when physical injury is absent, and connect patients showing combined risk immediately to hospital social work, victim advocacy, and safe crisis intervention pathways.

Limitations & cautions

High between-study heterogeneity across meta-analytic models (I² > 75%); high risk of bias identified in half of the included primary studies; relied largely on cross-sectional self-reported survey measures.
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Citations · exact source links

Trauma, violence & abuse (PubMed). Intimate Partner Violence and Suicide Risk among Women Presenting to Emergency Departments: A Systematic Review, Meta-Analysis, and Narrative Synthesis.

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Anesthesia and analgesia (PubMed)Oct 16, 2026Systematic Review

A meta-analysis of 25 randomized controlled trials with 3,344 surgical patients found perioperative ketamine and esketamine were associated with reduced postoperative delirium between days 2 and 7, but significantly increased postoperative dizziness.

Geriatrics Med-SurgAI summaryReview source

Systematic ReviewResearchMedication SafetyAI summary · original source linked below

Postoperative delirium (POD) is a common, distressing complication in older surgical patients, yet effective pharmacologic prevention options remain limited. This systematic review and meta-analysis of 25 randomized controlled trials (RCTs) involving 3,344 patients evaluated perioperative administration of ketamine (9 trials) and esketamine (16 trials) compared to placebo or standard care. Both agents were associated with reduced POD incidence (ketamine: risk ratio [RR] 0.69; 95% CI, 0.49–0.98; P = .04; esketamine: RR 0.58; 95% CI, 0.36–0.95; P = .03). Risk reductions were most evident with higher-dose regimens (single bolus: ketamine >0.5 mg/kg or esketamine >0.25 mg/kg; cumulative dose: ketamine >1.0 mg/kg or esketamine >0.5 mg/kg), bolus-plus-infusion administration, and in major surgical procedures. However, the preventative association was present only when delirium was assessed between postoperative days 2 and 7, not within the first 24 hours. Furthermore, ketamine/esketamine significantly increased the risk of postoperative dizziness (RR 1.45; 95% CI, 1.14–1.84; P = .002). Trial sequential analysis indicated that total evidence remains inconclusive due to insufficient overall sample size.

Key takeaways

Meta-analysis analyzed 25 RCTs with 3,344 patients receiving perioperative ketamine (9 trials) or esketamine (16 trials).
Both agents were associated with lower POD incidence versus control: ketamine RR 0.69 (P = .04) and esketamine RR 0.58 (P = .03).
Delirium reduction was apparent at postoperative days 2 to 7, but not during the initial 24 hours.
Dizziness risk was significantly elevated in treated patients (RR 1.45; 95% CI, 1.14–1.84; P = .002), and trial sequential analysis found cumulative sample size insufficient to draw definitive conclusions.

Why this matters on shift

Surgical and post-anesthesia nurses monitor older adults recovering from general anesthesia for confusion, agitation, and fall risk. While ketamine and esketamine show potential neurocognitive protective signals beyond day 1, their heightened dizziness profile increases post-op balance instability, requiring cautious bedside mobility precautions rather than unreserved clinical adoption.

Bedside takeaway

In a meta-analysis of 25 RCTs (3,344 patients), perioperative ketamine (RR 0.69) and esketamine (RR 0.58) reduced delirium at days 2–7 but significantly increased dizziness (RR 1.45).

Nursing implications

Screen surgical patients systematically for emergence and delayed delirium using validated tools (such as CAM or CAM-ICU) through postoperative day 7, implement strict fall and dizziness precautions when ketamine derivatives are administered, and avoid assuming early alertness guarantees absence of delayed delirium.

Limitations & cautions

Trial sequential analysis confirmed current evidence remains inconclusive due to inadequate total information size; dizziness was increased (RR 1.45); high heterogeneity in surgical populations and anesthesia protocols.
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Citations · exact source links

Anesthesia and analgesia (PubMed). Effects of Ketamine and Esketamine on Postoperative Delirium After General Anesthesia: A Meta-Analysis and Meta-Regression Analysis.

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Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Meta-analysis of 7,981 skull base surgeries finds extending antibiotic prophylaxis beyond 1 day does not reduce postoperative meningitis

Meta-analysis of 20 emergency department studies links intimate partner violence to three-fold higher suicide attempt risk

Meta-analysis of 25 RCTs finds perioperative ketamine and esketamine reduce postoperative delirium risk but increase dizziness