Ketamine in Adult Emergency Medicine: Controversies and Recent Advances

Ketamine in Adult Emergency Medicine: Controversies and Recent Advances

Download aqui!

Kendra Sih, Samuel G Campbell, John M Tallon, Kirk Magee, and Peter J Zed


OBJECTIVE: To review the evidence for the use of ketamine in adult emergency
medicine for procedural sedation and analgesia (PSA) and rapid sequence
intubation (RSI), as well as to focus on the issues of recovery agitation,
combination with propofol for PSA, and the use of ketamine as an induction
agent in patients with acute head injury in need of definitive airway management.

DATA SOURCES: PubMed (1949-July 2011), EMBASE (1980-July 2011), Google
Scholar (to July 2011), International Pharmaceutical Abstracts (1964-July 2011),
and Cochrane databases were searched independently. A manual search of
references was also performed.

STUDY SELECTION: English-language, full reports of experimental and observational
studies evaluating ketamine in adults undergoing PSA and RSI in the
emergency department (ED) were included if they reported efficacy or safety
outcomes.

DATA EXTRACTION: Two reviewers independently assessed each article for
inclusion, data extraction, and study limitations.

DATA SYNTHESIS: Six studies that used ketamine for PSA were included. The
majority reported adequate sedation with high patient satisfaction and lack of pain
and procedural recall. There is no evidence to support the superiority of a
combination of ketamine and propofol compared to propofol alone for PSA in
adults. Recovery agitation is common but can be minimized with premedication
with midazolam (number needed to treat 6). Two studies were identified that
evaluated the role of ketamine for induction during RSI in the ED. Although
ketamine is not a first-line agent for RSI, it is an alternative and may be used as
an induction agent in patients requiring endotracheal intubation.

CONCLUSIONS: Ketamine is an effective agent in adults undergoing PSA and RSI
in the ED. The best available evidence provides sufficient confidence to consider
use of this agent in the ED.

KEY WORDS: emergency medicine, intubation, ketamine, procedural sedation and
analgesia.

Ann Pharmacother 2011;45:1525-34.

Published Online, 6 Dec 2011, theannals.com, DOI 10.1345/aph.1Q370