A Comparative Analysis Between Ketamine Versus Combination of Midazolam and Haloperidol for Rapid Safe Control of Agitated Patients in Emergency Department: A Systematic Review

Abstract

We aim to discuss the efficacy and adverse effects of using ketamine in agitated patients in the emergency department (ED) compared with the combination therapy of haloperidol with benzodiazepine. This systematic review followed Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. An electronic search from PubMed/Medline, Cochrane library, and Google Scholar was conducted from their inception to 30 th April 2022. We included agitated patients in ED who were given infusion with ketamine only. Our comparative group was patients infused with combined therapy of haloperidol and benzodiazepine. We did not include letters, case reports, abstracts, conference papers, appraisals, reviews, and studies where full text was unavailable. We did not put any language restrictions. Three studies were selected in our manuscript (one cohort and two randomized controlled trials). All three studies showed that ketamine was used to achieve sedation in less time than the other group. However, two studies reported significantly more adverse effects in ketamine-infused groups.We concluded that ketamine use is superior when its primary focus is to sedate the patient as quickly as possible, but it carries some side effects that should be considered. However, we still need more studies assessing the efficacy of ketamine in agitated patients presenting in the ED.

Comparing the Safety and Effectiveness of Ketamine Versus Benzodiazepine/Opioid Combination for Procedural Sedation in Emergency Medicine: A Comprehensive Review and Meta-Analysis

“…Additionally, a recent randomized trial showed that even though the risk of vomiting was high with ketamine/midazolam, it was significantly associated with a shorter duration for the induction of sedation and offered a less painful procedure than the midazolam/fentanyl combination [ 37 ]. Our previous systematic review also deduced that ketamine is more efficient in providing sedation than a combination of ketamine and haloperidol; however, it was associated with a significant risk for hypertension and tachycardia; thus, it should be used while taking into consideration the complications [ 38 ]. Moreover, we have previously shown opioids alone may offer better analgesia for patients with hip fractures; however, it is far less superior to ultrasound-guided regional analgesia [ 39 ].…”

An Analytical Comparison Between Ketamine Alone and a Combination of Ketamine and Propofol (Ketofol) for Procedural Sedation and Analgesia From an Emergency Perspective: A Systematic Review and Meta-Analysis

“…Unfortunately, propofol use has some detrimental implications on the patients in some cases, such as hemodynamic compromise and respiratory depression; most of these effects depend on the dosage quantities. Additionally, according to a previous study, ketamine use is more effective when its main emphasis is to sedate the individual as fast as possible; however, it has some negative implications that must be considered [ 3 ]. Fortunately, despite the fact that the drug has been proven to have antiemetic and amnesiac effects, it is not analgesic [ 4 ].…”