Ketamine has been in use since its development as a dissociative anesthetic in the 1960s, but it was largely confined to the operating theater or austere environments until used by emergency physicians to facilitate painful procedures in children. As the unique effects of ketamine across its dose-response curve were understood, new applications emerged. In low doses, ketamine has found an important role alongside or instead of opioids in the management of severe pain, and methods to slow its absorption allow higher, more effective doses while attenuating psychoperceptual effects.
Our recent issue Current Concepts in Ketamine Therapy in the Emergency Department reviews ketamine’s effects across its unusual dose-response curve, knowledge of which is essential when using ketamine for any purpose.
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Here are a few key points:
- A patient receiving a dissociative dose of ketamine who is not already intubated may develop hypoventilation and requires continuous resuscitation-level monitoring.
- Partial dissociation causing psychiatric distress should be treated with additional ketamine at the outset of the procedure, or with titratable conventional sedatives (eg, midazolam).
- When using ketamine for analgesia, slow delivery via infusion, intranasal, IM, or nebulized administration reduces the intensity of psychoperceptual effects.
- Ketamine is not contraindicated in patients with increased intracranial pressure and may be preferable for use in the airway management of brain-injured patients because of its relative preservation of blood pressure.
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