Ketamine in Adult Emergency Medicine: Controversies and Recent Advances
Objective: To review the evidence for the use of ketamine in adult emergency medicine for procedural sedation and analgesia (PSA) and rapid sequence intubation (RSI), as well as to focus on the issues of recovery agitation, combination with propofol for PSA, and the use of ketamine as an induction a...
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Veröffentlicht in: | The Annals of pharmacotherapy 2011-12, Vol.45 (12), p.1525-1534 |
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creator | Sih, Kendra Campbell, Samuel G Talion, John M Magee, Kirk Zed, Peter J |
description | Objective:
To review the evidence for the use of ketamine in adult emergency medicine for procedural sedation and analgesia (PSA) and rapid sequence intubation (RSI), as well as to focus on the issues of recovery agitation, combination with propofol for PSA, and the use of ketamine as an induction agent in patients with acute head injury in need of definitive airway management.
Data Sources:
PubMed (1949-July 2011), EMBASE (1980-July 2011), Google Scholar (to July 2011), International Pharmaceutical Abstracts (1964-July 2011), and Cochrane databases were searched independently. A manual search of references was also performed,
Study Selection:
English-language, full reports of experimental and observational studies evaluating ketamine in adults undergoing PSA and RSI in the emergency department (ED) were Included if they reported efficacy or safety outcomes.
Data Extraction:
Two reviewers independently assessed each article for inclusion, data extraction, and study limitations.
Data Synthesis:
Six studies that used ketamine for PSA were included. The majority reported adequate sedation with high patient satisfaction and lack of pain and procedural recall. There is no evidence to support the superiority of a combination of ketamine and propofol compared to propofol alone for PSA in adults. Recovery agitation is common but can be minimized with premedication with midazolam (number needed to treat 6). Two studies were identified that evaluated the role of ketamine for induction during RSI in the ED, Although ketamine is not a first-line agent for RSI, it is an alternative and may be used as an induction agent in patients requiring endotracheal intubation.
Conclusions:
Ketamine is an effective agent in adults undergoing PSA and RSI in the ED. The best available evidence provides sufficient confidence to consider use of this agent in the ED. |
doi_str_mv | 10.1345/aph.1Q370 |
format | Article |
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To review the evidence for the use of ketamine in adult emergency medicine for procedural sedation and analgesia (PSA) and rapid sequence intubation (RSI), as well as to focus on the issues of recovery agitation, combination with propofol for PSA, and the use of ketamine as an induction agent in patients with acute head injury in need of definitive airway management.
Data Sources:
PubMed (1949-July 2011), EMBASE (1980-July 2011), Google Scholar (to July 2011), International Pharmaceutical Abstracts (1964-July 2011), and Cochrane databases were searched independently. A manual search of references was also performed,
Study Selection:
English-language, full reports of experimental and observational studies evaluating ketamine in adults undergoing PSA and RSI in the emergency department (ED) were Included if they reported efficacy or safety outcomes.
Data Extraction:
Two reviewers independently assessed each article for inclusion, data extraction, and study limitations.
Data Synthesis:
Six studies that used ketamine for PSA were included. The majority reported adequate sedation with high patient satisfaction and lack of pain and procedural recall. There is no evidence to support the superiority of a combination of ketamine and propofol compared to propofol alone for PSA in adults. Recovery agitation is common but can be minimized with premedication with midazolam (number needed to treat 6). Two studies were identified that evaluated the role of ketamine for induction during RSI in the ED, Although ketamine is not a first-line agent for RSI, it is an alternative and may be used as an induction agent in patients requiring endotracheal intubation.
Conclusions:
Ketamine is an effective agent in adults undergoing PSA and RSI in the ED. The best available evidence provides sufficient confidence to consider use of this agent in the ED.</description><identifier>ISSN: 1060-0280</identifier><identifier>EISSN: 1542-6270</identifier><identifier>DOI: 10.1345/aph.1Q370</identifier><identifier>PMID: 22147144</identifier><identifier>CODEN: APHRER</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Analgesia - methods ; Analgesics - administration & dosage ; Analgesics - adverse effects ; Biological and medical sciences ; Emergency Medicine - methods ; Emergency Service, Hospital ; Humans ; Hypnotics and Sedatives - administration & dosage ; Hypnotics and Sedatives - adverse effects ; Ketamine - administration & dosage ; Ketamine - adverse effects ; Medical sciences ; Pharmacology. Drug treatments ; Randomized Controlled Trials as Topic</subject><ispartof>The Annals of pharmacotherapy, 2011-12, Vol.45 (12), p.1525-1534</ispartof><rights>2011 SAGE Publications</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c345t-ef07a979f8a68804414ed48cfb7be87420daad4187069204fd9fb9d01aa42e923</citedby><cites>FETCH-LOGICAL-c345t-ef07a979f8a68804414ed48cfb7be87420daad4187069204fd9fb9d01aa42e923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1345/aph.1Q370$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1345/aph.1Q370$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=25335817$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22147144$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sih, Kendra</creatorcontrib><creatorcontrib>Campbell, Samuel G</creatorcontrib><creatorcontrib>Talion, John M</creatorcontrib><creatorcontrib>Magee, Kirk</creatorcontrib><creatorcontrib>Zed, Peter J</creatorcontrib><title>Ketamine in Adult Emergency Medicine: Controversies and Recent Advances</title><title>The Annals of pharmacotherapy</title><addtitle>Ann Pharmacother</addtitle><description>Objective:
To review the evidence for the use of ketamine in adult emergency medicine for procedural sedation and analgesia (PSA) and rapid sequence intubation (RSI), as well as to focus on the issues of recovery agitation, combination with propofol for PSA, and the use of ketamine as an induction agent in patients with acute head injury in need of definitive airway management.
Data Sources:
PubMed (1949-July 2011), EMBASE (1980-July 2011), Google Scholar (to July 2011), International Pharmaceutical Abstracts (1964-July 2011), and Cochrane databases were searched independently. A manual search of references was also performed,
Study Selection:
English-language, full reports of experimental and observational studies evaluating ketamine in adults undergoing PSA and RSI in the emergency department (ED) were Included if they reported efficacy or safety outcomes.
Data Extraction:
Two reviewers independently assessed each article for inclusion, data extraction, and study limitations.
Data Synthesis:
Six studies that used ketamine for PSA were included. The majority reported adequate sedation with high patient satisfaction and lack of pain and procedural recall. There is no evidence to support the superiority of a combination of ketamine and propofol compared to propofol alone for PSA in adults. Recovery agitation is common but can be minimized with premedication with midazolam (number needed to treat 6). Two studies were identified that evaluated the role of ketamine for induction during RSI in the ED, Although ketamine is not a first-line agent for RSI, it is an alternative and may be used as an induction agent in patients requiring endotracheal intubation.
Conclusions:
Ketamine is an effective agent in adults undergoing PSA and RSI in the ED. The best available evidence provides sufficient confidence to consider use of this agent in the ED.</description><subject>Adult</subject><subject>Analgesia - methods</subject><subject>Analgesics - administration & dosage</subject><subject>Analgesics - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Emergency Medicine - methods</subject><subject>Emergency Service, Hospital</subject><subject>Humans</subject><subject>Hypnotics and Sedatives - administration & dosage</subject><subject>Hypnotics and Sedatives - adverse effects</subject><subject>Ketamine - administration & dosage</subject><subject>Ketamine - adverse effects</subject><subject>Medical sciences</subject><subject>Pharmacology. Drug treatments</subject><subject>Randomized Controlled Trials as Topic</subject><issn>1060-0280</issn><issn>1542-6270</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkEtLxDAQgIMorq-Df0B6UfFQnaTpJvG2LL5QEUXPJU2m2qVN16Rd8N8b3VUvnmZgvnl9hOxTOKUZz8_0_O2UPmYC1sgWzTlLx0zAesxhDCkwCSOyHcIMABRlapOMGKNcUM63yNUt9rqtHSa1SyZ2aPrkokX_is58JPdoaxNr58m0c73vFuhDjSHRziZPaND1sWWhncGwSzYq3QTcW8Ud8nJ58Ty9Tu8erm6mk7vUxEP7FCsQWglVST2WEjinHC2XpipFiVJwBlZry6kUMFYMeGVVVSoLVGvOULFshxwv58599z5g6Iu2DgabRjvshlAoShWLC2QkT5ak8V0IHqti7utW-4-CQvGlrYjaim9tkT1YTR3KFu0v-eMpAocrQAejm8rHp-vwx-VZlksqIne05IJ-xWLWDd5FG_9s_AS5aICr</recordid><startdate>20111201</startdate><enddate>20111201</enddate><creator>Sih, Kendra</creator><creator>Campbell, Samuel G</creator><creator>Talion, John M</creator><creator>Magee, Kirk</creator><creator>Zed, Peter J</creator><general>SAGE Publications</general><general>Whitney</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111201</creationdate><title>Ketamine in Adult Emergency Medicine: Controversies and Recent Advances</title><author>Sih, Kendra ; Campbell, Samuel G ; Talion, John M ; Magee, Kirk ; Zed, Peter J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c345t-ef07a979f8a68804414ed48cfb7be87420daad4187069204fd9fb9d01aa42e923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Analgesia - methods</topic><topic>Analgesics - administration & dosage</topic><topic>Analgesics - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Emergency Medicine - methods</topic><topic>Emergency Service, Hospital</topic><topic>Humans</topic><topic>Hypnotics and Sedatives - administration & dosage</topic><topic>Hypnotics and Sedatives - adverse effects</topic><topic>Ketamine - administration & dosage</topic><topic>Ketamine - adverse effects</topic><topic>Medical sciences</topic><topic>Pharmacology. Drug treatments</topic><topic>Randomized Controlled Trials as Topic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sih, Kendra</creatorcontrib><creatorcontrib>Campbell, Samuel G</creatorcontrib><creatorcontrib>Talion, John M</creatorcontrib><creatorcontrib>Magee, Kirk</creatorcontrib><creatorcontrib>Zed, Peter J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Annals of pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sih, Kendra</au><au>Campbell, Samuel G</au><au>Talion, John M</au><au>Magee, Kirk</au><au>Zed, Peter J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ketamine in Adult Emergency Medicine: Controversies and Recent Advances</atitle><jtitle>The Annals of pharmacotherapy</jtitle><addtitle>Ann Pharmacother</addtitle><date>2011-12-01</date><risdate>2011</risdate><volume>45</volume><issue>12</issue><spage>1525</spage><epage>1534</epage><pages>1525-1534</pages><issn>1060-0280</issn><eissn>1542-6270</eissn><coden>APHRER</coden><abstract>Objective:
To review the evidence for the use of ketamine in adult emergency medicine for procedural sedation and analgesia (PSA) and rapid sequence intubation (RSI), as well as to focus on the issues of recovery agitation, combination with propofol for PSA, and the use of ketamine as an induction agent in patients with acute head injury in need of definitive airway management.
Data Sources:
PubMed (1949-July 2011), EMBASE (1980-July 2011), Google Scholar (to July 2011), International Pharmaceutical Abstracts (1964-July 2011), and Cochrane databases were searched independently. A manual search of references was also performed,
Study Selection:
English-language, full reports of experimental and observational studies evaluating ketamine in adults undergoing PSA and RSI in the emergency department (ED) were Included if they reported efficacy or safety outcomes.
Data Extraction:
Two reviewers independently assessed each article for inclusion, data extraction, and study limitations.
Data Synthesis:
Six studies that used ketamine for PSA were included. The majority reported adequate sedation with high patient satisfaction and lack of pain and procedural recall. There is no evidence to support the superiority of a combination of ketamine and propofol compared to propofol alone for PSA in adults. Recovery agitation is common but can be minimized with premedication with midazolam (number needed to treat 6). Two studies were identified that evaluated the role of ketamine for induction during RSI in the ED, Although ketamine is not a first-line agent for RSI, it is an alternative and may be used as an induction agent in patients requiring endotracheal intubation.
Conclusions:
Ketamine is an effective agent in adults undergoing PSA and RSI in the ED. The best available evidence provides sufficient confidence to consider use of this agent in the ED.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>22147144</pmid><doi>10.1345/aph.1Q370</doi><tpages>10</tpages></addata></record> |
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subjects | Adult Analgesia - methods Analgesics - administration & dosage Analgesics - adverse effects Biological and medical sciences Emergency Medicine - methods Emergency Service, Hospital Humans Hypnotics and Sedatives - administration & dosage Hypnotics and Sedatives - adverse effects Ketamine - administration & dosage Ketamine - adverse effects Medical sciences Pharmacology. Drug treatments Randomized Controlled Trials as Topic |
title | Ketamine in Adult Emergency Medicine: Controversies and Recent Advances |
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