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Ketamine procedural sedation in the emergency department of an urban tertiary hospital in Dar es Salaam, Tanzania
  1. Zlatan Coralic1,2,
  2. Hendry R Sawe3,4,
  3. Juma A Mfinanga3,4,
  4. Alfredo Cortez5,
  5. Jennifer Koehl6,
  6. Hannah Siroker7,
  7. Teri A Reynolds2,3
  1. 1 Department of Pharmacy, University of California San Francisco, San Francisco, California, USA
  2. 2 Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
  3. 3 Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  4. 4 Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
  5. 5 Global Health Sciences, University of California San Francisco, San Francisco, California, USA
  6. 6 Department of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
  7. 7 Department of Emergency Medicine, Highland Hospital, Oakland, California, USA
  1. Correspondence to Dr Zlatan Coralic, Departments of Pharmacy and Emergency Medicine, University of California San Francisco, San Francisco, CA 94146, USA; Zlatan.Coralic{at}


Study objective We describe ketamine procedural sedations and associated adverse events in low-acuity and high-acuity patients in a resource-limited ED.

Methods This was a prospective observational study of ketamine procedural sedations at the Emergency Medical Department at the Muhimbili National Hospital in Dar es Salaam, Tanzania. We observed consecutive procedural sedations and recorded patient demographics, medications, vital signs, pulse oximetry, capnography and a priori defined adverse events (using standard definitions in emergency medicine sedation guidelines). All treatment decisions were at the discretion of the treating providers who were blinded to study measurements to simulate usual care. Data collection was unblinded if predefined safety parameters were met. For all significant adverse and unblinding events, ketamine causality was determined via review protocol. Additionally, providers and patients were assessed for sedation satisfaction.

Results We observed 54 children (median 3 years, range 11 days–15 years) and 45 adults (median 33 years, range 18–79 years). The most common indications for ketamine were burn management in children (55.6%) and orthopaedic procedures in adults (68.9%). Minor adverse events included nausea/vomiting (12%), recovery excitation (11%) and one case of transient hypertension. There were nine (9%) patients who had decreased saturation readings (SpO2 ≤92%). There were three deaths, all in severely injured patients. After review protocol, none of the desaturations or patient deaths were thought to be caused by ketamine. No patient experienced ketamine-related laryngospasm, apnoea or permanent complications. Overall, ketamine was well tolerated and resulted in high patient and provider satisfaction.

Conclusion In this series of ketamine sedations in an urban, resource-limited ED, there were no serious adverse events attributable to ketamine.

  • analgesia/pain control
  • anaesthesia - general

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  • Contributors ZC, HRS, JAM and TR conceived and designed the study, and obtained research approvals. AC, JK and HS supervised the conduct of the study and data collection. ZC, HRS, JK and TR drafted the manuscript and all authors contributed substantially to its revision. ZC takes responsibility for the paper as a whole.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The Muhimbili University of Health and Allied Sciences’ Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at American Society of Health-System Pharmacist Mid Year Meeting; New Orleans, Louisiana, USA. December 2015.