The Emergency Department Experience with Prehospital Ketamine: A Case Series of 13 Patients

Prehospital Emergency Care, Vol. 16, No. 4, Pages 553-559

In order to better understand the risk–benefit ratio for the prehospital use of ketamine, the authors examined the emergency department (ED) courses of 13 patients to whom emergency medical services (EMS) had administered ketamine for chemical restraint.  Time from ketamine administration to peak sedation was <5 minutes in 11 patients and 20 minutes for two patients.

On emergency physician examination, five of 12 patients had Richmond Agitation Sedation Scale (RASS) scores of –5 (unarousable), one of 12 had a RASS score of –4 (deep sedation), four of 12 had RASS scores of –3 (moderate sedation), and two of 12 had RASS scores of –2 (light sedation). Three patients developed hypoxia, two in the ED and one prior to hospital arrival. Two of these patients required intubation and one was treated with jaw thrust. Indications for intubation were recurrent laryngospasm and intracranial bleeding. One additional patient experienced a single episode of hypersalivation, which was successfully treated with suctioning of the oropharynx. Of the nonintubated patients, three of 10 were diagnosed with an emergence reaction and five of 10 required additional sedation. The primary diagnosis on ED disposition was drug/ethanol intoxication (3), psychosis (4), intracranial bleeding (1), seizure (1), suicidal ideation (1), agitation (1), and altered mental status (1).

In these 13 patients, ketamine produced moderate or deeper sedation and respiratory complications included hypoxia, laryngospasm, and hypersalivation. Emergence reactions occurred in 30% of nonintubated patients, but they were successfully treated with small doses of benzodiazepines.

http://informahealthcare.com/doi/abs/10.3109/10903127.2012.695434