Ketamine in the ED: Medical politics versus patient care

Sobel, Richard M.; Morgan, Barry W; Murphy, Michael

doi:10.1016/s0735-6757(99)90169-9

Cited by 24 publications

(8 citation statements)

References 48 publications

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“…25 Surprisingly, the use of ketamine, which has some advantages with regard to lower rates of respiratory depression or hypotension, 11,26,27 and from which the hazards of psychic emergence reactions have been exaggerated, 28 was uncommon in this case series. We reported 1 case in which succinylcholine was used by an anesthesiologist in the ED because it was entered in to our database.…”

Section: Discussionmentioning

confidence: 81%

“…3,6,7 The use of propofol, ketamine and etomidate have become commonplace in the ED as a result. 2,[8][9][10][11][12][13] The literature has supported this change for patients of all ages, [12][13][14] and even for those with significant pre-existing disease. 15,16 Evidence supports the use of such agents even in settings outside the ED or operating room by supervised nurses or by physicians without formal advanced airway or cardiac life support training.…”

Section: Introductionmentioning

confidence: 97%

“…1,22,23 Objections by anesthesiologists have resulted in restrictions of drugs like propofol to the operating room in some hospitals. 11,22 These objections are often based on the relative paucity of published data when compared with that accrued in the operating room. 22 In their 2002 "Practice guidelines for sedation and analgesia by non-anesthesiologists," the American Society of Anesthesiologists (ASA) place emergency physicians under the same umbrella as dentists, radiologists and gastroenterologists.…”

Section: Introductionmentioning

confidence: 99%

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Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

Campbell

Magee

Kovács

et al. 2006

CJEM

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Objectives:To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital. Methods: Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period. Results: Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%-2.3%), and desaturation (SaO 2 ≤ 90) in 14 of 979 (1.4%; CI 0.1%-2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs. Conclusions: Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

Campbell

Magee

Kovács

et al. 2006

CJEM

View full text Add to dashboard Cite

show abstract

“…[6][7][8] Apart from a report on nurses from the endoscopy department, ours is the only study to show sedation competence by nurses from non-anaesthesiology departments. 9 The overall complication rate of about 4% for the patients supervised by the emergency nurses in this study compares well with complication rates of 1-23% in university settings.…”

Section: Discussionmentioning

confidence: 86%

The safety of single-physician procedural sedation in the emergency department

Hogan

Sacchetti

Aman

et al. 2006

Emergency Medicine Journal

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Background: Pevious research has shown the safety of procedural sedation in the emergency department in university settings involving multiple emergency physicians. Objective: To examine sedation in the emergency department conducted by a single emergency physician with monitoring by the emergency nurse. Methods: The Procedural Sedation in the Community Emergency Department Registry is a prospective observational database of procedural sedation cases directed by the emergency physicians. Among other parameters, the registry tracts whether emergency physicians or emergency nurses monitored patient sedation. The incidence of complications and outcomes were compared between these two monitoring groups. Results: 1028 procedural sedations were performed on 977 patients at 14 sites. In 885 (86.1%) cases the emergency physician directed the sedation, and performed the procedure with monitoring by the emergency nurse. Complications occurred in 42 (4.1%) patients, 35 (4.0%) EN monitored patients and 6 (4.2%) EP monitored patients (p.0.7). Procedures were successful in 863 (97.5%) cases monitored by emergency nurses and in 140 (97.9%) patients monitored by emergency physicians (p.0.7). Conclusion: Procedural sedation in the emergency department performed by a single emergency physician is safe and effective.

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“…Although a newer generation of agents such as fentanyl and midazolam offer the advantage of shorter medication half-life, the incidence of respiratory compromise is still present [3,4]. Procedural sedation and analgesia using ketamine and midazolam may be an alternative in adult patients in the ED setting.…”

Section: Discussionmentioning

confidence: 99%

To study the effectiveness and safety of ketamine and midazolam procedural sedation in the incision and drainage of abscesses in the adult emergency department

Sim

Seet²

2008

European Journal of Emergency Medicine

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The objective of the report was to study the efficacy and safety of ketamine and midazolam combination in the procedural sedation of incision and drainage of abscesses in the adult emergency department (ED) patients. This prospective observational study enrolled patients aged 16-60 years (American Society of Anesthesiologists class I) requiring abscess drainage in an adult ED. Patients received 2 mg/kg of ketamine infusion over 5 min and midazolam 2-5 mg titrated to deep sedation according to Ramsay sedation scale. Primary outcome was patient satisfaction using pain score after procedure. Secondary outcomes included adverse effects, hemodynamics alterations and recovery time. Descriptive statistics were calculated using SPSS software. Fifteen patients were recruited. One patient was excluded because of difficulty with pain score interpretation. Seventy-nine percent were male patients. The mean age was 29. The mean size of abscess was 3.4 cm. The mean dose of midazolam was 3.2 mg. Eighty-six percent did not experience any pain for the procedure. Only two patients (14%) reported mild pain during the procedure. There were no significant adverse events or complications. Three patients had giddiness, two had vomiting and only one reported an unpleasant dream. The median systolic blood pressure and heart rate elevation were 30+/-5.1 mmHg and 12.5+/-3.2/min, respectively. The median time for blood pressure and pulse rate to return to baseline was 20+/-2.7 min. The use of ketamine and midazolam sedation is both well tolerated and effective for adults in the ED undergoing incision and drainage of abscesses. This study is limited by the small sample size.

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Ketamine in the ED: Medical politics versus patient care

Cited by 24 publications

References 48 publications

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series

The safety of single-physician procedural sedation in the emergency department

To study the effectiveness and safety of ketamine and midazolam procedural sedation in the incision and drainage of abscesses in the adult emergency department

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