Looking for help with ketamine in the field. My service is looking into the use of ketamine on the ambulance. Any help will be greatly appreciated.
Scott RB said:
I don't doubt that it can do what it says it does, but is it better and/or safer than what is already used? And one does not necessarily need to perform an RCT (though ideal) to get an idea of safety and efficacy.
It's just like any other medicine: it has its up and down sides, and times you use it, and times you don't. I like it, it's one of my favorite drugs, and sometimes I use it on patients as well. ;)
I don't like to use it for RSI in normotensive, non-asthmatic patients because it seems to take longer than etomidate to work, and doesn't give you quite as much relaxation. There are even a few case reports of laryngospasm, though of course that isn't a problem with some paralytic on board. I am a huge fan of using ketamine drips for continued sedation in intubated hypotensive patients, and of course there's the slight bronchodilating effects for RSI in asthmatics. I've not used it much for pain, but you typically don't when Dilaudid is available. :)
Since no one develops a tolerance to it, it's pretty reliable in terms of sedation, unlike benzos. Versed is one of my least favorite drugs--there are lots of people who just will not go down with it. So it is better than some things out there, but with caveats.
Caveat example: some docs use it during sedations combined with propofol, to counteract the hypotension-inducing effects of propofol, but in my N of 2, I've caused apnea twice that way, so I can't say I'm a fan. But the studies say it's just as safe as propofol alone....