Adverse events associated with ketamine for procedural sedation in adults

ABSTRACT Objectives: Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) as part of emergency department (ED) treatment. We compared adverse events (AEs) using a variety of sedation regimens. Methods: This was a retrospective analysis of a PSA safety audit in two urban EDs. Consecutive self-reported IDUs were identified, and structured data describing comorbidities, vital signs, sedation regimens (propofol [P], propofol-fentanyl [PF], fentanyl-midazolam [FM], ketofol [1:1 ketamine:propofol, KF], and ketamine-propofol [KP]) and AEs were collected. The primary outcome was the proportion of patients in each sedation group having an AE; the secondary outcome was the proportion of patients having a cardiovascular or respiratory AE. Results: Data were collected on 276 IDUs (78 P, 82 PF, 65 FM, 25 KF, and 26 KP), and 18 patients had AEs (6.5%, 95% CI 4.0–10.3). The AE rates were 0.0%, 8.5%, 9.2%, 12.0%, and 7.6%, respectively, with propofol having a significantly lower rate (Pearson coefficient 14.9, p = 0.007). The cardiovascular/respiratory AE rates were significantly different as well, with P, KP, and KF having the lowest rates (Pearson coefficient 13.3, p = 0.01). Conclusions: For IDU PSA, the overall AE rate was 6.5%, and propofol appeared to have a significantly lower rate.

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Risk Factors for Adverse Events in Emergency Department Procedural Sedation for Children

JAMA Pediatrics ◽

10.1001/jamapediatrics.2017.2135 ◽

2017 ◽

Vol 171 (10) ◽

pp. 957 ◽

Cited By ~ 33

Author(s):

Maala Bhatt ◽

David W. Johnson ◽

Jason Chan ◽

Monica Taljaard ◽

Nick Barrowman ◽

...

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Adverse Events ◽

Procedural Sedation

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Emergency Drug Kits: Pharmacological and Technical Considerations

Anesthesia Progress ◽

10.2344/0003-3006-61.4.171 ◽

2014 ◽

Vol 61 (4) ◽

pp. 171-179 ◽

Cited By ~ 5

Author(s):

Daniel E. Becker

Keyword(s):

Adverse Events ◽

Continuing Education ◽

General Anesthesia ◽

Intraoperative Monitoring ◽

Preoperative Assessment ◽

Procedural Sedation ◽

Dental Procedures ◽

Dental Practices ◽

Emergency Drugs ◽

Technical Considerations

Abstract The risk for complications while providing dental procedures is greatest when caring for patients having significant medical compromise. It is comforting that significant adverse events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, the office team must be prepared to manage untoward events should they arise. This continuing education article will address basic emergency drugs that should be available in all dental practices and additional agents that become essential for those practices providing various levels of procedural sedation or general anesthesia.

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Incidence and predictors of respiratory adverse events in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department

Singapore Medical Journal ◽

10.11622/smedj.2020095 ◽

2020 ◽

Author(s):

JL Lee ◽

LP Tham

Keyword(s):

Emergency Department ◽

Adverse Events ◽

Procedural Sedation ◽

Paediatric Emergency Department ◽

Paediatric Emergency

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Definition and Incidence of Adverse Events

The Pediatric Procedural Sedation Handbook ◽

10.1093/med/9780190659110.003.0021 ◽

2018 ◽

pp. 136-140

Author(s):

David Fagin

Keyword(s):

Side Effects ◽

Adverse Events ◽

Supportive Care ◽

American Academy ◽

Procedural Sedation ◽

Patient Harm ◽

Timely Manner ◽

Psychological Conditions ◽

American Academy Of Pediatrics ◽

National Organizations

To perform effective and safe procedural sedation, one must be knowledgeable about the adverse events that can occur with the administration of various sedatives and analgesics. Adverse events (sometimes thought of as complications of care) are often predictable if the sedationist properly assesses the patient’s physiologic and psychological conditions and understands the side effects of the medications administered and the procedural conditions that may exacerbate risk. With such preparation, the sedationist can monitor for the event and can either prevent it or provide supportive care in a timely manner. The American Academy of Pediatrics and other national organizations have developed guidelines for caring for patients requiring procedural sedation with the intent of informing sedationists of the risks involved in sedation care and the skills and equipment needed to ameliorate or prevent patient harm. Adverse events can be classified as minor, moderate, and major.

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