Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update
Citations
621 citations
Additional excerpts
...Innes, 1997; Weber et al., 2004; Green et al., 2011; Gao et al., 2016)....
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455 citations
Cites background from "Clinical Practice Guideline for Eme..."
...Many recent studies have described the use of ketamine administered with propofol to evoke deep sedation levels during painful ED procedures.(11-20)...
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...respirations, and cardiopulmonary stability.(1,11) In the ED, ketamine is commonly administered to evoke dissociative levels of sedation....
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...During recent years, there has been a continuously growing body of evidence addressing ketamine, midazolam, fentanyl, propofol, and etomidate that significantly adds to the depth of understanding of these agents’ use in the ED.(1,11-20,30,39,43,58,61-88) The use of short-acting sedative agents such as propofol and etomidate for ED procedural sedation and analgesia has gained widespread acceptance....
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...Multiple studies have continued to support this practice.(11,70-76,89) Studies addressing the use of ketamine as a sole agent in the adult procedural sedation and analgesia ED population have also been published....
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254 citations
Cites background from "Clinical Practice Guideline for Eme..."
...[43] This dissociative sedation can be readily achieved by administration of a single IV or IM loading dose of ketamine followed by titration.[43] Intranasal ketamine is being used in a wide range of clinical doses for procedural sedation in children (0....
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...It is useful for procedures in the mentally disabled who are often uncooperative.[43] This dissociative sedation can be readily achieved by administration of a single IV or IM loading dose of ketamine followed by titration....
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...the drug continues to be widely administered in the operation theatres as an inexpensive and simple alternative to inhalational anesthesia.[43] In African countries and rural India where there is a paucity of anesthetic manpower, equipment and money, ketamine plays a major role in anesthetic service delivery in secondary health care facilities and in high-risk cases in tertiary institutions....
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237 citations
Cites background from "Clinical Practice Guideline for Eme..."
...However, anecdotal observations suggest a higher risk of airway complications with ketamine in infants less than 3 months of age (Green and Johnson, 1990; Green et al., 2011), likely due to infant-specific differences in airway reactivity and anatomy rather than ketamine itself....
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163 citations
References
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"Clinical Practice Guideline for Eme..." refers background in this paper
...Coadministered Benzodiazepines As with anticholinergics, the prophylactic coadministration of benzodiazepines has been traditionally recommended with the intent of preventing or reducing recovery reactions.(4,12,15,16) A single controlled trial in ED adults found that midazolam pretreatment (0....
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...Isomers The 2 optimal isomers of ketamine, R( ) and S( ), have different properties, but the literature is inconclusive about whether this might be clinically important.(4,12,15,16,110) The S( ) ketamine may exhibit enhanced dissociative/analgesic potency, greater amnesia, faster elimination, and fewer recovery reactions and may have neuroprotective effects....
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...Coadministered Anticholinergics Traditionally the prophylactic coadministration of an anticholinergic (ie, atropine or glycopyrrolate) has been routinely recommended, with the intent of mitigating oral secretions and thus presumably airway adverse events.(1,12,15,16) However, large case series of patients have been safely treated without this adjunct....
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...Shortly after the release of ketamine in 1970, anecdotal associations between upper respiratory infection and laryngospasm appeared, and as a result essentially every ketamine review article or textbook chapter lists upper respiratory infection as a contraindication.(1,4,12,15,16) There is insufficient evidence to clarify what specific magnitude of upper respiratory infection signs and symptoms should preclude ketamine administration....
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...According to inconclusive evidence, it has been widely recommended that ketamine be avoided in children or adults with known or possible coronary artery disease, congestive heart failure, or hypertension.(12,15,16,43) Ketamine inhibits the reuptake of catecholamines, and the resulting sympathomimetic effect produces mild to moderate increases in blood pressure, pulse rate, cardiac output, and myocardial oxygen consumption....
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