Guidelines for use of ketamine in emergency department (ED) procedural sedation have been updated for the first time since 2004; the use of ketamine has been expanded to include adults and babies between 3 and 12 months of age, according to a new report.
Study Highlights.
Changes since the 2004 guidelines include the following:
- The updated guidelines now support expansion of ketamine use to children aged 3 to 12 months, which is younger than previously recommended, as well as to adults.
- Minor oropharyngeal procedures and head trauma are no longer contraindications to ketamine use.
- Emergency medicine physicians should administer ketamine intravenously instead of intramuscularly whenever feasible because recovery is faster and there is less emesis.
- Routine use of prophylactic anticholinergic medications is no longer recommended.
- Routine use of prophylactic benzodiazepines is not recommended for children but may be helpful in adults (eg, midazolam 0.03 mg/kg intravenously; number needed to benefit = 6).
- Prophylactic use of ondansetron may slightly reduce vomiting (number needed to benefit ≥ 9)
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