Ketamine for Procedural Sedation and Analgesia by Nonanesthesiologists in the Field: A Review for Military Health Care Providers

Abstract

Military health care providers located in field environments frequently face situations in which procedural sedation and analgesia are necessary, without the advantage of sophisticated monitoring equipment. Ketamine is a unique agent that can be administered either intravenously or intramuscularly to produce predictable and profound analgesia, with an exceptional safety profile. We review the issues unique to ketamine and provide a practical guide for the use of ketamine for adult and pediatric patients in a field environment.

Ketamine Psychedelic Psychotherapy: Focus on its Pharmacology, Phenomenology, and Clinical Applications

“…Today, combat medics continue using ketamine for battlefield sedation and pain management because of its minimal impact on medic carrying capacity and ability to withstand environmental extremes. It is also much more field expedient than any other analgesic due to its low occurrence of side effects (Guldner, Petinaux, Clemens, Foster, & Antoine, 2006). In a recent review of analgesic options for pain relief on the battlefield, Black and McManus (2009) wrote that, in sub-anesthetic doses, ketamine is almost ideal as an analgesic due to providing profound-pain relief, potentiating opioids, preventing opioid hyperalgesia, and its margin of safety.…”

Role of ketamine for analgesia in adults and children

“…[2] The dosage is well-established single bolus and consistent across patients. [3] It has been suggested in animals that in addition to low-grade analgesia and high dose anesthesia ketamine could work in synergy with opioids at a dose termed the third dose range of ketamine where ketamine would be devoid of analgesic effects. [4] Clinical studies are required to confirm the third dose effect of ketamine in humans.…”

“…Ketamine is a highly lipid soluble dose-dependent anesthetic and analgesic that can be administered orally, rectally, intranasally, IV, IM, or intrathecally. [3] It has been successfully applied for nociceptive and neuropathic pain. [3] Although ketamine is known to increase intracranial pressure, it has been tolerated during neurosurgical procedures and patients have not sustained neurological damage following cardiopulmonary surgery.…”

“…[3] It has been successfully applied for nociceptive and neuropathic pain. [3] Although ketamine is known to increase intracranial pressure, it has been tolerated during neurosurgical procedures and patients have not sustained neurological damage following cardiopulmonary surgery. [4] Nociceptive stimuli are known to trigger the release of catecholamines.…”

“…[36] Due to the potential for hallucinations, patients with psychiatric ailments or those abusing alcohol or amphetamines should not receive ketamine, as it may worsen preexisting conditions. [3]…”