Ketamine as a First-Line Agent for Sedation of Agitated Patients?

A small study suggests that ketamine is more effective than alternatives; larger studies are needed to assess safety.

Ketamine has a long history as a veterinary tranquilizer and is familiar to emergency physicians because it is a frequently used, safe, effective agent for procedural sedation and rapid sequence intubation. But can it be used to control behavior in severely agitated patients? In a prior summary of a study on this topic (NEJM JW Emerg Med Mar 2016 and Ann Emerg Med 2016; 67:581), we raised concerns about ketamine's propensity to cause endogenous catecholamine release — what might happen when agitated patients are exposed to even more catecholamines? Now investigators report on a small prospective observational study comparing five regimens for sedation of acutely agitated patients: ketamine (24 patients), lorazepam (33), midazolam (17), halo…

Reviewing Author

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Grant/Research SupportAgency for Healthcare Research and Quality; CDC; NIH–National Center for Advancing Translational Sciences; NIH–National Institute of Allergy and Infectious Diseases (NIAID); NIH–NIAID–Antibacterial Resistance Leadership Group; Merck; Pfizer; Boehringer-Ingelheim; Shire; Portola Pharmaceuticals, Inc.; Novartis; bioMérieux; Siemens; Rapid Pathogen Screening; Magnolia; Stago; Innovative Biosensors; Molecular Detection, Inc.; Dyax Corp.; Trius Pharmaceuticals

Daniel J. Pallin, MD, MPH

Disclosures

Consultant/Advisory BoardPortola Pharmaceuticals, Inc.

Speaker’s BureauPeerView Institute for Medical Education

Ketamine as a First-Line Agent for Sedation of Agitated Patients?

Topics

Reviewing Author