Ketamine sedation for orthopedic procedures in a high complexity emergency service: a descriptive study
Rapid recovery and low cost are among the benefits of ketamine for emergency sedation. It has been excluded as the first choice because of the associated adverse events.
To describe the adverse events associated with the use of ketamine in a high-complexity emergency service.
Materials and methods:
Review of clinical records of patients who received sedation with ketamine for orthopedic procedures in the emergency room between January 2012 and June 2015, with identification of adverse events.
Overall, 354 patients were identified (74% males, 32% children), with a median age of 21 years, interquartile range (IQR) of 20 years. Of them, 66% had upper limb injuries, 79% were treated on an outpatient basis, with a median length of stay in the emergency service of 3.6hours (IQR 2,5). In 98%, sedation was given by a different practitioner from the orthopedic surgeon. Ketamine and midazolam were administered together in the same proportion, and 3 or more medications were used in 13% of cases. Overall, 14 adverse events (3.9%) were described, 9 related to desaturation between 80% and 90% which was solved with oxygen through nasal cannula, 3 were cases of vomiting following sedation with no aspiration, and 2 were cases of desaturation <80% which were managed with oxygen administration through a cannula and maneuvers to maintain airway patency. One patient had visual hallucinations. No patient required advanced airway maneuvers.
The use of ketamine for sedation in the emergency service is associated with a low prevalence of major adverse events. Sedation with ketamine and midazolam appears to be a safe strategy for these procedures.
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