The adverse effects of Ketamine on Procedural Sedation and Analgesia (PSA) in the Emergency Department

Abstract

Background: Procedural sedation and analgesia (PSA) in the emergency department (ED) is mainly used for wound irrigation, reduction of fractures, and wound closure. Ketamine is one of the most commonly used drugs for PSA in the ED. The study was conducted in the ED of a large tertiary care hospital in southern India to evaluate the adverse effects of Ketamine on PSA. Materials and Methods: This is a prospective observational study performed in the ED for 6 months (October 2019–March 2020) in 151 patients who required Ketamine for PSA. Titrated doses of Ketamine was administered in all patients; hemodynamic variables and adverse events were recorded at timed intervals. Results: During the study period, a total of 151 patients in the ED required PSA. The mean age of the study Cohort was 37 ± 15 years, and males accounted for 83%. All individuals obtained adequate sedation and pain relief. It was found that the incidence of adverse reactions to Ketamine was higher in young people (18- to 40-year-old), which was 63%. The most common adverse reaction in the study population was 39 cases of hypertension (44.8%), followed by vomiting in 25 cases (28.7%) and delusion in 6 cases (4%). There was no significant adverse effect in any patients which necessitated admission. Conclusion: Ketamine is a drug with good analgesic, sedative properties and has been shown to have a good safety profile with minimal adverse events for use as PSA in ED. Side effects were most common in the younger adult age group and hypertension was the most common side effect.

A Case of Hepatotoxicity Induced by Therapeutic Ketamine Use for Sedation

“…During the early stages of the SARS-CoV-2 (COVID-19) pandemic, ketamine was widely employed as an alternative sedative agent to allow for lung protective ventilation while patients received mechanical ventilation when other preferred agents were in short supply [ 2 ]. Although therapeutic use of ketamine is generally well tolerated and therefore widely used due to its limited safety profile compared to other sedatives [ 3 , 4 ], long-term use at high doses may warrant consideration of its toxicities [ 5 ]. While it is not well known that ketamine may be associated with liver toxicities, it has been reported that prolonged use, repeated use, or abuse of ketamine may lead to liver injury [ 6 , 7 ].…”

Exploring effects and experiences of ketamine in group couples therapy

“…Ketamine targets glutamate pathways, increasing the synaptic release of glutamate while also promoting neuroplasticity (Abdallah et al, 2018). Possible adverse side effects of ketamine include nausea, confusion, vomiting, and dysphoria (Dilip, Chandy, Hazra, Selvan, & Ganesan, 2021).…”