Hypothesis: Intranasal administration of ketamine would reduce the intramuscular pain of ketamine injection in children who undergo procedural sedation and analgesia in the emergency department.

Ketamine is a well-known medication in children's procedural sedation and analgesia. While it provides good analgesia along with sedation, its injection is painful and causes distress in children. Intranasal administration of Ketamine would reduce the intramuscular pain of ketamine injection in children who undergo procedural sedation and analgesia in the emergency department. This will also assess if intranasal administration would affect the depth of sedation and hospital length of stay of this group of patients.

Inclusion Criteria:

• Children who need to undergo procedural sedation and analgesia

Exclusion Criteria:

• Weight over 33 Kg
• No Consent from parents/patient
• Needs immediate procedure due to patient's condition
• Growth/mental retardation
• Sensory deficit at the site of intramuscular injection

We will blind medication administrator, care provider, and assessor in addition to the patients.