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Auditor�a
de la seguridad y la eficacia de la ketamina para la sedaci�n de
procedimientos en el servicio de
urgencias
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Audit
of the safety and effectiveness of ketamine for procedural sedation
in the emergency department
J M Vardy, N Dignon, N Mukherjee, D M Sami, G Balachandran, S
Taylor.
Emerg Med J 2008;25:579-582
doi:10.1136/emj.2007.056200
Abstract
Aim: To examine the effectiveness and safety of the sedative agents
used in the emergency department following the introduction of
ketamine as an agent for procedural sedation. Methods: A 2-year
prospective audit of sedation practice was undertaken. This
specifically examined the rationale behind a doctor's choice of
sedative agent, the depth of sedation achieved, adverse events and
the time taken to regain full orientation. Results: 210 patients
were included of whom 85 (40%) were given ketamine, 107 (51%)
midazolam and 18 (9%) propofol. The median time to full orientation
was 25 min for ketamine, 30 min for midazolam and 10 min for
propofol. Complications occurred in 15.9% of sedations overall
(14.6% of those given ketamine, 15.8% given midazolam and 22.2%
given propofol). Apnoea and hypoxia most often occurred with
midazolam and propofol, while hypertension and hypertonicity were
encountered more frequently with ketamine. In addition, 19.5% of
patients given ketamine suffered the re-emergence phenomenon. The
association between deep sedation with no response to pain and
adverse events encountered with midazolam does not occur with
ketamine. Conclusions: Ketamine is both safe and effective and
compares favourably with midazolam as an agent for procedural
sedation in the emergency department. Although the re-emergence
phenomenon occurred, no psychological sequelae were encountered
after return to full orientation. Ketamine may be particularly
useful in groups of patients at high risk of adverse effects with
midazolam
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