Ketamine as rescue treatment for difficult-to-sedate severe acute behavioral disturbance in the emergency department

Isbister, Geoffrey Kennedy, Calver, Leonie A., Downes, Michael A. and Page, Colin B. (2016) Ketamine as rescue treatment for difficult-to-sedate severe acute behavioral disturbance in the emergency department. Annals of Emergency Medicine, 67 5: 581-587e1. doi:10.1016/j.annemergmed.2015.11.028


Author Isbister, Geoffrey Kennedy
Calver, Leonie A.
Downes, Michael A.
Page, Colin B.
Title Ketamine as rescue treatment for difficult-to-sedate severe acute behavioral disturbance in the emergency department
Journal name Annals of Emergency Medicine   Check publisher's open access policy
ISSN 1097-6760
0196-0644
Publication date 2016-02-18
Sub-type Article (original research)
DOI 10.1016/j.annemergmed.2015.11.028
Open Access Status Not Open Access
Volume 67
Issue 5
Start page 581
End page 587e1
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Mosby
Collection year 2017
Language eng
Formatted abstract
Study objective:  We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturbance who have failed previous attempts at sedation.

Methods:  This was a prospective study of patients given ketamine for sedation who had failed previous sedation attempts. Patients with severe acute behavioral disturbance requiring parenteral sedation were treated with a standardized sedation protocol including droperidol. Demographics, drug dose, observations, and adverse effects were recorded. The primary outcome was the number of patients who failed to sedate within 120 minutes of ketamine administration or requiring further sedation within 1 hour.

Results:  Forty-nine patients from 2 hospitals were administered rescue ketamine during 27 months; median age was 37 years (range 20-82 years); 28 were men. Police were involved with 20 patients. Previous sedation included droperidol (10 mg; 1), droperidol (10+10 mg; 33), droperidol (10+10+5 mg; 1), droperidol (10+10+10 mg; 11), and combinations of droperidol and benzodiazepines (2) and midazolam alone (1). The median dose of ketamine was 300 mg (range 50 to 500 mg). Five patients (10%; 95% confidence interval 4% to 23%) were not sedated within 120 minutes or required additional sedation within 1 hour. Four of 5 patients received 200 mg or less. Median time to sedation postketamine was 20 minutes (interquartile range 10 to 30 minutes; 2 to 500 minutes). Three patients (6%) had adverse effects, 2 had vomiting, and a third had a transient oxygen desaturation to 90% after ketamine that responded to oxygen.

Conclusion:  Ketamine appeared effective and did not cause obvious harm in this small sample and is a potential option for patients who have failed previous attempts at sedation. A dose of 4 to 5 mg/kg is suggested, and doses less than 200 mg are associated with treatment failure.
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Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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