Daily Bolus of LR: Ketamine use for procedural sedation
Leave a commentMay 26, 2011 by dailybolusoflr
Ketamine
· Ketamine is a dissociative anesthetic that is used more commonly in children for the performance of procedures
· It is rapidly absorbed by the cerebral tissue and metabolized by the liver
· Administration
o In the ED, we typically use either IV or IM administration
o It can also be given rectally and orally
· Dose, Onset and Duration
o IV 1-2mg/kg; onset 1 minute; duration 15-30 minutes
o IM 4-6mg/kg; onset 5 minutes; duration 30-40 minutes
o Repeat doses at half the intial dose are recommended as needed
· Complications and Side Effects
o Emergence Phenomenon
§ more commonly seen in patients over the age of 10
§ less common with IM injection
§ most recent report was just under 40% of adult patients had this in the small sample of patients in the 2010 study comparing propofol and ketamine (citation at the bottom)
§ pre-treatment recommended with benzodiazepines for adults, for children- unclear that it is necessary
o Hypersalivation
§ Previous guidelines had pre-treatment with low dose atropine or glycopyrrolate (anticholinergic)
§ Most recent clinical practice guidelines do not support prophylactic use, but rather when situational need occurs
o Respiratory Depression
§ Rare- treat with oxygen as needed
o Laryngospasm
§ Rare, but if occurs- BVM attempts and if failed, consider paralytics
o Emesis
§ Rare
§ Appears to be at its peak in early adolescents
§ Higher associated with IM
o Elevated HR and BP
§ Frequent
§ Related to ketamines ability to block reuptake of circulating catecholamines
ACADEMIC EMERGENCY MEDICINE 2010; 17:604–611 (propofol and ketamine)
Ann Emerg Med. 2011;57:449-461 (practice guidelines- nice article summary)
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions
