Ketamine sedation – what do like with your special K?
August 7, 2012
I must declare a “conflict of interest”. I love ketamine, therefore anything you read from here on in is likely seriously biased. Ketamine has had a big resurgence in popularity over the past 5 years in anaesthesia and ED practice. There have been plenty of papers looking at its use for procedural sedation in the last few years. Last week I got into a minor Twitter-debate with @jvrbntz @keeweedoc and @PBSherren about current practice and evidence.
But when I look around my ED, and talk to colleagues in other places I find that there is a wide range of practice when it comes to using ketamine for procedural sedation. So I thought I would open up a forum for discussion and link in some evidence for us all to consider and try to reach some consensus.
Here are the basic ways I see people using ketamine, and the drugs that get used with it in order to reduce side-effects or improve the sedation.
Straight ketamine. Do you like it IMI or IV (or maybe even intranasal?)
Ketafol (K + propofol): What is the ratio to use? What dose? In one or 2 syringes?
Antisialogogue ? Atropine or glycopyrrolate
Benzos – midazolam (or other) – before, with or after K?
Antiemetics: ondansetron, droperidol, metoclopramide? Routine or as required?
Monitoring – what do you use as a standard?
Oxygen or no oxygen during sedation?
Strategies for avoiding emergence phenomena – how do you do it?
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact