ketamine for sedation and analgesia in adults

3 Jul

ketamine is an option?

benefits: provides dissociation, analgesia, and sedation, while keeping respiratory drive intact.

In a patient with severe lung disease this could prove a better option than intubation if definitive care was forthcoming and intubation could lead to longterm and difficult ventilatory weaning.

For patients who are protecting their airway, awake, able to report their pain scale and do not have significant secretions, ketamine may be more reasonable.

 

A 2010 study (Lester L et al.)

  • retrospective study of 35 patients who received low-dose ketamine (0.1 to 0.6mg/kg), excluding those with procedural sedation
  • nearly all cases also having received opioids,
  • pain improvement was noted in 54% of cases.
  • Doses ranged from 5 to 35 mg

 

What about longer term sedation?

There is not a significantly large amount of literature using ketamine in ICU mechanically ventilated patients to recommend its routine use for this purpose at this time.

however one abstract by Arnold, et al in Critical Care Medicine, December 2012 comments on a retrospective analysis of 12 patients who did received ketamine sedation or analgesia.

The abstract discussed use in mechanically ventilated patients although it did not give specifics on how many of the patients were in fact intubated.

Also termination of ketamine was for high heart rate or blood pressures, which appeared to be mitigated by use of concomitant benzodiazepines.

 

Small numbers, small data, but food for thought.

 

Submitted by J. Stone.

 

References: Lester L et al. Low-dose ketamine for analgesia in the ED: a retrospective case series. Am J Emerg Med. 2010 Sep;28(7):820-7.; picture

 

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