Abstract
Objective
Ketamine for rapid sequence intubation (RSI) is typically dosed at 1 to 2 mg/kg intravenously.
The need to ensure dissociation during RSI led some to administer ketamine at doses
greater than 2 mg/kg. This study assessed associations between ketamine dose and adverse
events.
Methods
This multisite, retrospective study included adult subjects undergoing RSI with intravenous
ketamine. Subjects were categorized into 2 groups: a standard ketamine dose (≤ 2 mg/kg
intravenously) or a high dose (> 2 mg/kg intravenously). Odds ratios (ORs) and 95%
confidence intervals (CIs) were calculated for adverse events.
Results
Eighty subjects received standard-dose ketamine, and 50 received high-dose ketamine. The
high-dose group had a significantly (P < .05) higher proportion of trauma patients, were younger, and had higher predose
blood pressure compared with the standard-dose group. High-dose ketamine was associated
with greater odds of adverse events including hypotension (OR = 7.0; 95% CI, 3.0-16.6),
laryngospasm (OR = 10.8; 95% CI, 1.3-93.4), bradycardia (OR = 7.5; 95% CI, 1.5-36.6),
repeat medications (OR = 12.9; 95% CI, 1.5-107.9), oxygen desaturation (OR = 6.0;
95% CI, 1.8-19.9), multiple attempts (OR = 3.2; 95% CI, 1.5-6.8%), and failed airway
(OR = 3.6; 95% CI, 1.0-12.7).
Conclusion
Ketamine at higher doses was associated with increased odds of adverse events. Studies
assessing adverse events of ketamine at lower than standard doses in shock patients
are needed.
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Article info
Publication history
Published online: December 04, 2020
Footnotes
Supported by Mercy Health North St. Vincent Medical Center Graduate Medical Education/Academic Affairs as required by the Accreditation Council for Graduate Medical Education for support of residency program research and scholarly activity.
Identification
Copyright
© 2020 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
