Safety and effectiveness of ketamine

This prospective audit evaluates the outcome of ketamine sedation in the emergency department in comparison with midazolam and propofol. The incidence of adverse events was similar with all three drugs. The authors report, however, that despite significantly more patients in the ketamine group being sedated to a level of no-response, the incidence of apnoea and hypoxia was lower than for both midazolam and propofol. The incidence of adverse events was significantly higher with deeper levels of sedation with midazolam, but not with ketamine. Although, not surprisingly, re-emergence phenomena occurred more frequently with ketamine (and particularly in younger patients) than with the other agents, there were no persistent psychological symptoms and only midazolam was significantly associated with recall of the intervention. Increasing age resulted in longer times to recovery with midazolam, but not with ketamine. Importantly, they report that midazolam is most often selected as the agent of choice due to the clinician’s familiarity with the drug, whereas ketamine was most frequently selected on the basis of its pharmacological profile. This paper describes an excellent example of simple, pragmatic research …