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Ketamine agitation

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https://www.readbyqxmd.com/read/30197153/ketamine-for-rapid-sedation-of-agitated-patients-in-the-prehospital-and-emergency-department-settings-a-systematic-review-and-proportional-meta-analysis
#1
Scott L Mankowitz, Pat Regenberg, Janina Kaldan, Jon B Cole
BACKGROUND: Rapid tranquilization of agitated patients can prevent injuries and expedite care. Whereas antipsychotics and benzodiazepines are commonly used for this purpose, ketamine has been suggested as an alternative. OBJECTIVE: The aim of this systematic review is to determine the safety and effectiveness of ketamine to sedate prehospital and emergency department (ED) patients with undifferentiated agitation. METHODS: Studies and case series of patients receiving ketamine for agitation were included...
September 6, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30118360/outcomes-of-prehospital-chemical-sedation-with-ketamine-versus-haloperidol-and-benzodiazepine-or-physical-restraint-only
#2
Laurel O'Connor, Matthew Rebesco, Conor Robinson, Karen Gross, Andrew Castellana, Mark J O'Connor, Marc Restuccia
OBJECTIVE: The goal of this study is to describe complications and outcomes of prehospital ketamine use for agitation as compared to other methods of physical or chemical restraint such as haloperidol plus benzodiazepine or physical restraint only. METHODS: We conducted a single-center retrospective review of patient encounters in which restraint was administered in the prehospital setting. At the beginning of our study window, only physical restraint was available to paramedics managing agitated patients but subsequently, haloperidol and benzodiazepines were introduced, followed by ketamine 2 years later...
August 27, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/30032884/comparison-of-nebulised-dexmedetomidine-ketamine-or-midazolam-for-premedication-in-preschool-children-undergoing-bone-marrow-biopsy
#3
H S Abdel-Ghaffar, S M Kamal, F A El Sherif, S A Mohamed
BACKGROUND: The aim of our study was to compare the efficacy of dexmedetomidine, ketamine, and midazolam for sedative premedication administered by nebuliser 30 min before general anaesthesia in preschool children undergoing bone marrow biopsy and aspiration. METHODS: Ninety children aged 3-7 yr were randomly allocated into three equal groups to be premedicated with either nebulised ketamine 2 mg kg-1 (Group K), dexmedetomidine 2 μg kg-1 (Group D), or midazolam 0...
August 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/30031556/the-characteristics-and-prevalence-of-agitation-in-an-urban-county-emergency-department
#4
James R Miner, Lauren R Klein, Jon B Cole, Brian E Driver, Johanna C Moore, Jeffrey D Ho
STUDY OBJECTIVE: We seek to determine the characteristics and prevalence of agitation among patients in an urban county emergency department (ED). METHODS: This was a prospective observational study of ED patients at an urban Level I trauma center. All ED patients were screened during daily randomized 8-hour enrollment periods. Adult agitated patients, defined as having an altered mental status score greater than 1, were included. Trained research volunteers collected demographics and baseline data, including the presenting altered mental status score, use and type of restraints, and whether any initial sedative was given...
July 18, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29967888/the-use-of-continuous-ketamine-for-analgesia-and-sedation-in-critically-ill-patients-with-opioid-abuse-a-case-series
#5
Cierra N Treu, Christine M Groth, Jignesh H Patel
Managing pain and agitation in patients with opioid abuse is becoming more common in intensive care units. Tolerance to commonly used agents is often observed, leading to inadequate pain control and increased agitation. Ketamine's unique mechanism of action and opioid-sparing effects make it an ideal agent for patients with suboptimal response to opioid therapy. This report describes our experience using continuous ketamine infusions for analgesia and sedation in four mechanically ventilated patients with histories of opioid abuse that had suboptimal response to standard therapy...
October 2017: Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/29847468/ketamine-anesthesia-does-not-improve-depression-scores-in-electroconvulsive-therapy-a-randomized-clinical-trial
#6
Charles William Carspecken, Anna Borisovskaya, Shu-Tsui Lan, Katherine Heller, Jonathan Buchholz, David Ruskin, Irene Rozet
BACKGROUND: Although interest in ketamine use during electroconvulsive therapy (ECT) has increased, studies have been equivocal with regard to its efficacy. The aims of this clinical trial were to evaluate ketamine's antidepressive effects in ECT as a primary anesthetic, determine ketamine's tolerability when compared with standard anesthesia, and determine if plasma brain-derived neurotrophic factor (BDNF) is necessary for treatment response. MATERIALS AND METHODS: Adults meeting criteria for treatment-resistant depression undergoing index course ECT received either methohexital (1 to 2 mg/kg) or ketamine (1 to 2 mg/kg) anesthesia in this dual-arm double-blinded randomized clinical trial (NCT02752724)...
October 2018: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/29800375/a-non-comparative-prospective-pilot-study-of-ketamine-for-sedation-in-adult-septic-shock
#7
Jason M Reese, Victoria Fernandes Sullivan, Nathan L Boyer, Cristin A Mount
Introduction: Sedation and analgesia in the intensive care unit (ICU) for patients with sepsis can be challenging. Opioids and benzodiazepines can lower blood pressure and decrease respiratory drive. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that provides both amnesia and analgesia without depressing respiratory drive or blood pressure. The purpose of this pilot study was to assess the effect of ketamine on the vasopressor requirement in adult patients with septic shock requiring mechanical ventilation...
May 24, 2018: Military Medicine
https://www.readbyqxmd.com/read/29791238/low-dose-ketamine-infusion-for-adjunct-management-during-vaso-occlusive-episodes-in-adults-with-sickle-cell-disease-a-case-series
#8
Nicole Palm, Catherine Floroff, Tanna B Hassig, Alice Boylan, Julie Kanter
The optimal management of recurrent painful episodes in individuals living with sickle cell disease (SCD) remains unclear. Currently, the primary treatment for these episodes remains supportive, using fluids and intravenous opioid and anti-inflammatory medications. Few reports have described the use of adjunct subanesthetic doses of ketamine to opioids for treatment of refractory pain in SCD. This article reports a retrospective case series of five patients admitted to the intensive care unit (ICU) with prolonged vaso-occlusive episodes (VOEs)...
May 23, 2018: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/29742583/adjunct-ketamine-use-in-the-management-of-severe-ethanol-withdrawal
#9
Anthony F Pizon, Michael J Lynch, Neal J Benedict, Joseph H Yanta, Adam Frisch, Nathan B Menke, Greg S Swartzentruber, Andrew M King, Michael G Abesamis, Sandra L Kane-Gill
OBJECTIVES: Ketamine offers a plausible mechanism with favorable kinetics in treatment of severe ethanol withdrawal. The purpose of this study is to determine if a treatment guideline using an adjunctive ketamine infusion improves outcomes in patients suffering from severe ethanol withdrawal. DESIGN: Retrospective observational cohort study. SETTING: Academic tertiary care hospital. PATIENTS: Patients admitted to the ICU and diagnosed with delirium tremens by Diagnostic and Statistical Manual of Mental Disorders V criteria...
August 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29656945/ketamine-versus-ketamine-pluses-atropine-for-pediatric-sedation-a-meta-analysis
#10
REVIEW
Jiaxiao Shi, Ang Li, Zhijian Wei, Yang Liu, Cong Xing, Hongyu Shi, Han Ding, Dayu Pan, Guangzhi Ning, Shiqing Feng
OBJECTIVES: The application of atropine for pediatric sedation in the emergency department remains controversial. Our objective was to perform a comprehensive review of the literature and assess the clinical indexes in groups with and without atropine use. METHODS: PubMed, EMBASE, and the Cochrane Library were searched for randomized and non-randomized studies that compared ketamine and ketamine plus atropine for pediatric sedation. The risk ratio with 95% confidence interval was calculated using either a fixed- or random-effects model according to the value of I2 ...
July 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29651740/the-expanding-role-of-ketamine-in-the-emergency-department
#11
Sophia Sheikh, Phyllis Hendry
Patients frequently come to the emergency department for pain. For decades, ketamine has been used in the emergency department for procedural sedation but is now receiving attention as a potential alternative to opioids because of its unique analgesic effects. Additionally, ketamine's dissociative properties have made it a popular choice for sedating profoundly agitated patients. In this narrative review, these new roles for ketamine in the emergency department are discussed.
May 2018: Drugs
https://www.readbyqxmd.com/read/29609881/-ketamine-as-an-adjunct-to-bupivacaine-in-infra-orbital-nerve-block-analgesia-after-cleft-lip-repair
#12
Hala Saad Abdel-Ghaffar, Nawal Gad Elrab Abdel-Aziz, Mohamed Fathy Mostafa, Ahmed Kamal Osman, Nehad Mohamed Thabet
OBJECTIVES: We conducted this study to investigate the safety and analgesic efficacy of the addition of Ketamine to Bupivacaine in bilateral extra-oral infra-orbital nerve block in children undergoing cleft lip surgeries. METHODS: Sixty patients were randomly allocated into two groups (n=30), Group B received infra-orbital nerve block with 2mL of 0.25% Bupivacaine and Group BK received 0.5mg.kg-1 Ketamine for each side added to 1mL of 0.5% Bupivacaine solution diluted up to 2mL solution to 0...
May 2018: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29551622/treatment-of-behavior-disturbances-with-ketamine-in-a-patient-diagnosed-with-major-neurocognitive-disorder
#13
Douglas Steenblock
A 77-year-old woman who had been previously diagnosed with a major neurocognitive disorder became highly agitated and aggressive in a long-term care facility. She did not respond to intramuscular (IM) haloperidol plus lorazepam and had to be transported to the local emergency department (ED). In the ambulance, she remained highly agitated and was given 200 mg IM ketamine. Within minutes of receiving this, she de-escalated dramatically with no apparent adverse effects and remained stable for several days. Although ketamine has been used recently in pre-hospital settings and EDs to reduce agitated behavior, there has been little if any investigation of its potential for reducing behavior disturbances in patients who suffer from major neurocognitive disorders...
June 2018: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/29534713/palliative-sedation-in-germany-factors-and-treatment-practices-associated-with-different-sedation-rate-estimates-in-palliative-and-hospice-care-services
#14
Stephanie Stiel, Mareike Nurnus, Christoph Ostgathe, Carsten Klein
BACKGROUND: Clinical practice of Palliative Sedation (PS) varies between institutions worldwide and sometimes includes problematic practices. Little available research points at different definitions and frameworks which may contribute to uncertainty of healthcare professionals in the application of PS. This analysis investigates what demographic factors and characteristics of treatment practices differ between institutions with high versus low sedation rates estimates in Palliative and Hospice Care in Germany...
March 13, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29464385/prevention-of-emergence-agitation-with-ketamine-in-rhinoplasty
#15
Canser Yilmaz Demir, Nureddin Yuzkat
BACKGROUND: Emergence agitation (EA), defined as restlessness, disorientation, excitation, and/or inconsolable crying, is a common phenomenon during early recovery from general anesthesia. In this study, we aimed to determine the (1) EA incidence after rhinoplasty operations in adults; (2) the effects of ketamine administered at sub-anesthetic doses just 20 min before the end of the surgery in rhinoplasty operations on agitation level, postoperative pain, side effects, and complications; and (3) to determine the risk factors for EA in adults after rhinoplasty...
February 20, 2018: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/29405806/delayed-sequence-intubation-by-intensive-care-flight-paramedics-in-victoria-australia
#16
Jacinta Waack, Matthew Shepherd, Emily Andrew, Stephen Bernard, Karen Smith
OBJECTIVE: Delayed sequence intubation (DSI) involves the administration of ketamine to facilitate adequate preoxygenation in the agitated patient. DSI was introduced into the Clinical Practice Guideline for Intensive Care Flight Paramedics in Victoria in late 2013. We aimed to describe the clinical characteristics of patients receiving DSI. METHODS: A retrospective analysis was undertaken of patients who received DSI between January 1, 2014, and December 31, 2016, during both primary response and retrieval missions...
September 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29395692/approach-to-the-agitated-emergency-department-patient
#17
Michael Gottlieb, Brit Long, Alex Koyfman
BACKGROUND: Acute agitation is a common occurrence in the emergency department (ED) that requires rapid assessment and management. OBJECTIVE: This review provides an evidence-based summary of the current ED evaluation and management of acute agitation. DISCUSSION: Acute agitation is an increasingly common presentation to the ED and has a broad differential diagnosis including metabolic, neurologic, infectious, toxicologic, and psychiatric etiologies...
April 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29193185/ketamine-infusion-for-adjunct-sedation-in-mechanically-ventilated-adults
#18
Lara M Groetzinger, Ryan M Rivosecchi, William Bain, Marshall Bahr, Katherine Chin, Bryan J McVerry, Ian Barbash
BACKGROUND: Many critically ill patients receive ketamine for adjunct sedation despite a paucity of evidence on its use, dosing, and monitoring in this setting. OBJECTIVE: To describe the dosing and safety considerations of ketamine for adjunct sedation in a population of mechanically ventilated critically ill patients targeting light sedation. METHODS: We conducted a retrospective review of mechanically ventilated patients receiving continuous ketamine infusion between January 2012 and April 2016...
February 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#19
REVIEW
Lauren M Linder, Clint A Ross, Kyle A Weant
Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
January 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/29033344/a-prospective-study-of-ketamine-as-primary-therapy-for-prehospital-profound-agitation
#20
Jon B Cole, Lauren R Klein, Paul C Nystrom, Johanna C Moore, Brian E Driver, Brandon J Fryza, Justin Harrington, Jeffrey D Ho
OBJECTIVE: We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation. METHODS: This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality...
May 2018: American Journal of Emergency Medicine
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