Ketamine Use for Acute Agitation in the ED
Ketamine Use for Acute Agitation in the ED
Over the study period, 459 patients who received ketamine in the ED were identified. Thirty-two cases involving 27 patients met study inclusion and exclusion criteria and were subjected to further analysis. The remaining 427 patient visits received ketamine for non-agitation-related causes, primarily for procedural sedation or induction of intubation. One autistic, nonverbal patient who was uncooperative with treatment received ketamine on five separate visits. The age range of the study group was from 9 to 77 years (average age of 35 ± 16 years; 20 males). Weight was recorded in five patient visits. Discharge diagnoses, age, and gender for each patient are listed in Table 1.
A total of 17 patient visits received intramuscular (i.m.) ketamine, and 15 received intravenous (i.v.) administration. In 18 (56.2%) cases, a patient received medication for agitation prior to being administered ketamine, most often a combination of an antipsychotic and a benzodiazepine. On 20 patient visits (62.5%), additional calming medication was utilized, most often additional ketamine. In eight (25%) visits, both pre- and postadministration medication was required. Thirteen patients intoxicated with alcohol or other substances (40.6%) required additional calming medication at a higher rate than those who were not (84.6% vs. 47.4%). A summary of medication and intoxication can be found in Table 2. In no cases were dysphoric emergence reactions noted, and in no cases did patients return to the ED for noted exacerbations of psychiatric conditions due to ketamine.
There were sufficient data to evaluate postadministration change in systolic blood pressure (SBP) in 22 visits with an average preadministration SBP of 131 ± 20 mm Hg. Within 4 h of administration, the highest recorded SBP for each patient showed an average increase of 17 ± 25 mm Hg from the patient's baseline. The lowest recorded SBP in the same time period showed an average drop of 14 ± 24 mm Hg. Change in heart rate was evaluated in 25 cases; the average preadministration heart rate was 98 ± 23 beats/min. The average highest increase from baseline was 8 ± 17 beats/min, and the largest decrease was 10 ± 18 beats/min. Twenty-two cases provided oxygen saturation data in which the preadministration average was 98 ± 2%. Postadministration average highest increase was 1.1 ± 1.7%, and average largest decrease was 0.6 ± 2.2%. No patients became hypoxic; the lowest oxygen saturation after administration was 94%. A summary of change in SBP and heart rate can be found in Table 3.
Results
Over the study period, 459 patients who received ketamine in the ED were identified. Thirty-two cases involving 27 patients met study inclusion and exclusion criteria and were subjected to further analysis. The remaining 427 patient visits received ketamine for non-agitation-related causes, primarily for procedural sedation or induction of intubation. One autistic, nonverbal patient who was uncooperative with treatment received ketamine on five separate visits. The age range of the study group was from 9 to 77 years (average age of 35 ± 16 years; 20 males). Weight was recorded in five patient visits. Discharge diagnoses, age, and gender for each patient are listed in Table 1.
A total of 17 patient visits received intramuscular (i.m.) ketamine, and 15 received intravenous (i.v.) administration. In 18 (56.2%) cases, a patient received medication for agitation prior to being administered ketamine, most often a combination of an antipsychotic and a benzodiazepine. On 20 patient visits (62.5%), additional calming medication was utilized, most often additional ketamine. In eight (25%) visits, both pre- and postadministration medication was required. Thirteen patients intoxicated with alcohol or other substances (40.6%) required additional calming medication at a higher rate than those who were not (84.6% vs. 47.4%). A summary of medication and intoxication can be found in Table 2. In no cases were dysphoric emergence reactions noted, and in no cases did patients return to the ED for noted exacerbations of psychiatric conditions due to ketamine.
There were sufficient data to evaluate postadministration change in systolic blood pressure (SBP) in 22 visits with an average preadministration SBP of 131 ± 20 mm Hg. Within 4 h of administration, the highest recorded SBP for each patient showed an average increase of 17 ± 25 mm Hg from the patient's baseline. The lowest recorded SBP in the same time period showed an average drop of 14 ± 24 mm Hg. Change in heart rate was evaluated in 25 cases; the average preadministration heart rate was 98 ± 23 beats/min. The average highest increase from baseline was 8 ± 17 beats/min, and the largest decrease was 10 ± 18 beats/min. Twenty-two cases provided oxygen saturation data in which the preadministration average was 98 ± 2%. Postadministration average highest increase was 1.1 ± 1.7%, and average largest decrease was 0.6 ± 2.2%. No patients became hypoxic; the lowest oxygen saturation after administration was 94%. A summary of change in SBP and heart rate can be found in Table 3.
