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IV Ketamine Is Effective for Procedural Sedation in Adults

But its safety is not yet clear.

Ketamine is commonly used for procedural sedation in children, but its use in adults has not been well studied. Researchers in England conducted a prospective, observational study of adult patients who received intravenous ketamine for procedural sedation at a single emergency department during a 2-year period. Patients with contraindications to ketamine, such as ischemic heart disease, congestive heart failure, and previous psychotic illness, were excluded. Patients received an initial ketamine dose of 0.5 mg/kg, and the dose was repeated if sedation was inadequate after 5 minutes.

Adequate sedation was achieved in 91 of 92 patients and was achieved after one dose in 46 patients. The procedure was successfully completed in 98% of patients. Overall, 22% of patients had adverse events, including vomiting (4%), clonic movements (4%), and agitation (13%). Midazolam successfully treated agitation in all 7 of the 12 agitated patients who required treatment. During sedation, heart rate increased by a mean of 30.2 beats per minute, and systolic blood pressure increased by a mean of 25.4 mm Hg.

Comment: Ketamine is an attractive agent for procedural sedation because it maintains airway protective reflexes while providing both analgesic and sedative effects. However, emergence reactions and increases in BP and heart rate raise concerns about its use in adults. Emergence reactions necessitated the use of midazolam in 7% of study patients. In addition, patients in whom BP and heart rate increases could cause potential harm were excluded, so no conclusions can be drawn about ketamine’s safety in such patients.

— Diane M. Birnbaumer, MD, FACEP

Published in Journal Watch Emergency Medicine September 5, 2008

Citation(s):

Newton A and Fitton L. Intravenous ketamine for adult procedural sedation in the emergency department: A prospective cohort study. Emerg Med J 2008 Aug; 25:498.

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