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Ketamine: a unique drug with several potential uses in the prehospital setting

07 October 2011
Features
02 October 2011
Volume 3 · Issue 10

Abstract

Ketamine is an anaesthetic agent that does not depress a patient's respiratory drive, setting it apart from other sedatives such as benzodiazepines. It has historically been used in austere environments with few resources for close monitoring under anaesthetia. More recently, it has found frequent use in paediatric specialties to facilitate painful procedures, but also seen use in adults. Commonly used in emergency departments by physician-level providers, it has found a use in the prehospital setting. Case reviews, as well as retrospective and prospective studies, have examined its use by physicians and paramedics in the prehospital setting. Ketamine offers several potential uses for paramedics including analgesia, sedation, and airway management; but thorough understanding of the drug and its unique effects is critical for safe use.

Sedation and analgesia are critical skills for practitioners in the prehospital setting. Safe, effective, and predictable medications are required to achieve these aims. This is particularly true when prehospital personnel operate on written protocols or algorithms. Opioids and benzodiazepines are most commonly used, but can be limited by adverse effects such as excessive sedation, hypotension, or respiratory depression. Ketamine, a rapid-acting anaesthetic agent, has a unique set of properties that set it apart from most other sedatives. Studies have shown a variety of potential uses for ketamine in the emergency department, and further studies are suggesting that some of these uses may be expanded to paramedics in the prehospital setting.

Ketamine was developed by Parke-Davis in 1962 in an attempt to develop a safer alternative to phencyclidine (PCP). It was initially used medically on American soldiers in Vietnam. Ketamine has subsequently been used as an analgesic and anaesthetic since the late 1970s. It has been used in combat, wilderness, and disaster situations, particularly in developing countries or other circumstances where advanced anaesthesia resources and monitoring are not available (Bonanno, 2002).

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Agent
Ketamine
Physician
Treatment