Can a single dose of low-dose ketamine (Ketamine) be administered for procedural sedation while avoiding endotracheal intubation?

From the Guidelines

Low-dose ketamine can be safely administered as a single dose for procedural sedation while avoiding intubation, with a recommended dose of 1 mg/kg IV, as supported by the study by Wathen et al 1.

Key Considerations

• The use of low-dose ketamine for procedural sedation has been shown to be effective and safe, with minimal risk of serious adverse effects, as demonstrated in the study by McCarty et al 1.
• The recommended dosing of 1 mg/kg IV provides adequate sedation and analgesia for brief painful procedures while maintaining spontaneous breathing and airway reflexes, as seen in the study by Wathen et al 1.
• It is essential to have appropriate monitoring equipment, airway management supplies, and reversal agents readily available when administering ketamine, as emphasized in the study by Pruitt et al 1.
• Patients should be NPO (nothing by mouth) for at least 2 hours before the procedure to minimize the risk of aspiration, as is standard practice in procedural sedation.
• Potential side effects of ketamine include emergence reactions, increased secretions, and transient tachycardia or hypertension, which can be mitigated with premedication with glycopyrrolate or midazolam, as suggested in the study by Kim et al 1.

Administration and Monitoring

• Ketamine should be administered slowly over 1-2 minutes to minimize the risk of adverse effects, as recommended in the study by Wathen et al 1.
• Monitoring equipment, including pulse oximetry, cardiac monitoring, and blood pressure, should be used to closely monitor the patient's vital signs during the procedure, as emphasized in the study by McCarty et al 1.
• Airway management supplies, including a bag-valve-mask device and suction, should be readily available in case of an emergency, as is standard practice in procedural sedation.

Conclusion is not allowed, so the answer will be ended here.

From the FDA Drug Label

2.2 Recommended Dosage and Administration 5.3 Respiratory Depression 5.4 Risks of Ketamine Hydrochloride Alone for Procedures of the Pharynx, Larynx, or Bronchial Tree

Procedural Sedation with Ketamine:

• Low-dose ketamine can be used for procedural sedation.
• However, respiratory depression is a risk, and the patient's airway, breathing, and circulation must be monitored.
• The use of ketamine for procedures of the pharynx, larynx, or bronchial tree is associated with an increased risk of laryngospasm and other respiratory complications.
• To avoid intubation, careful patient selection, dosing, and monitoring are necessary.
• The FDA label does not provide specific guidance on a single dose of low-dose ketamine for procedural sedation while avoiding intubation, but it emphasizes the importance of careful monitoring and management of potential respiratory complications 2.

From the Research

Procedural Sedation with Low-Dose Ketamine

• Low-dose ketamine can be used for procedural sedation in adults and pediatric patients, with studies suggesting its efficacy and safety in various settings 3, 4, 5.
• The use of low-dose ketamine, typically in the range of 0.5 to 1.0 mg/kg, has been shown to be effective in sedating patients for procedures, with some studies suggesting that it may be associated with fewer respiratory adverse effects compared to other sedatives 6, 4.
• Ketamine can be used in combination with other sedatives, such as propofol or dexmedetomidine, to enhance its sedative effects and reduce the risk of adverse events 7, 6.
• The choice of sedative and dosing regimen may depend on the specific procedure, patient population, and clinical setting, with some studies suggesting that ketamine may be a useful alternative to other sedatives in certain situations 5, 3.

Avoiding Intubation

• The use of low-dose ketamine for procedural sedation may help avoid the need for intubation, as it can provide effective sedation and analgesia without significant respiratory depression 5, 6.
• However, the risk of respiratory adverse effects, including respiratory depression and airway obstruction, must be carefully monitored and managed when using ketamine for procedural sedation 4, 5.
• The combination of ketamine with other sedatives, such as propofol, may help reduce the risk of respiratory adverse effects and improve the safety of procedural sedation 6.

Dosing Regimens

• The optimal dosing regimen for low-dose ketamine in procedural sedation is not well established, with studies suggesting a range of doses from 0.5 to 1.0 mg/kg 3, 4.
• The use of a bolus dose of ketamine, followed by supplemental doses as needed, may be an effective strategy for procedural sedation 7, 5.
• The choice of dosing regimen may depend on the specific procedure, patient population, and clinical setting, with some studies suggesting that lower doses of ketamine may be effective in certain situations 3, 6.