Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update
(Reblogged from ALIEM)
1. Adults have been included in the 2011 guidelines.
2. Adjunctive medications
- Prophylactic ondansetron can help reduce vomiting. The number needed to benefit = 9.
- No need to co-administer atropine or glycopyrrolate for oral secretions.
- Prophylactic midazolam 0.3 mg/kg may prevent recovery reactions in adults (but not children). The number needed benefit = 6.
- Age < 3 months because of risk of airway complications
- Known or suspected schizophrenia (even if currently stable)
- Head trauma has been removed as a contraindication.
4. Route of administration
- IV administration appears to be preferred over IM, because of faster recover and fewer episodes of emesis.
- IV route: Peak concentration and onset = 1 min, duration of dissociation = 5-10 min, time from dose-to-discharge = 50-110 min
- IM route: Peak concentration and onset = 5 min, duration of dissociation = 20-30 min, time from dose-to-discharge = 60-140 min
- Laryngospasm has been reported to be around 0.3%. What do you do when this happens? You’ll just have to read this previous post to find out.
Green SM, Roback MG, Kennedy RM, Krauss B. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update. Annals of emergency medicine. 2011 – in press. PMID: 21256625