Ketamine for adults while intubated?

NurseBatzy · Oct 31, 2011

I don't know of any reason it would be used, maybe someone else has a better answer for you, but I can tell you this: In my hospital, adults do not get ketamine. Period. It's too hard on the limbic system in adults, and has the potential to cause flashbacks and psychosis long after its use. I know during my schooling at a different hospital, I saw it used along with propofol, but only for induction, no drip. I'd like to hear from someone who has experience with this, you've piqued my interest!

mh356, BSN, RN, EMT-B · Oct 31, 2011

We recently had a patient that had a reaction to ketamine after surgery. She was transferred to us for care. I thought it was odd too since I never hear of it being used but I guess some hospitals still do use it. The patient was young-18 y.o.; don't know if that makes a difference in choosing which drug to go with.

mcleanl · Oct 31, 2011

I've seen it used for bedside procedures (in adults) along with versed but never in drip form. I was taught to minimize stimulation and talking near the patient while ketamine is in use to prevent flashbacks/psychosis.

GilaRRT · Oct 31, 2011

Ketamine has several potential benefits:

It can augment cardiac output.

It has analgesic, amnesic, sedative and anaesthetic properties.

It can preserve protective reflexes.

It may be beneficial over medications such as etomidate in severe sepsis and septic shock.

May be beneficial in patients experiencing bronchospasm.

Used it a fair amount over seas with good success. It's such an important medication the WHO has it on their essential medications list. There is a growing movement that supports using it over etomidate in certain situations within the United States.

brownbook · Oct 31, 2011

Just a wild guess, but I wonder if the shortage of so many drugs is part of it? We could not get propofol for a while. Anesthesia used something similar to propofol. I can't remember what it was, I'm sure it wasn't ketamine, I would have remembered that. Whatever it was it has a much longer half life and we had to admit one patient for what was to be out patient surgery to the hospital for the night.

nrsang97, BSN, RN · Oct 31, 2011

In my unit we only had one pt on a ketamine drip. We found it was one thing that finally broke his status epilepticus. We had tried versed, propofol, pentobarb, and this was a last resort.

Munch · Oct 31, 2011

Ketamine in used a lot in peds patients for minor procedures(for example bone marrow biopsies or aspirations). In my hospital it is sometimes used as rapid induction for intubations. When I had my neurosurgery They used a cocktail of medications. They used propofol, fentanyl and droperidol. Also to calm me down when I was waiting on the OR table prepping me they injected me with versed. Keep in mind this is just the hospital I went to(which happens to be the hospital I work at) and I am NOT anesthesiologist. All hospitals are different as well as all doctors have their favorite medications they like to use. One doctor uses one or two certain types of medications, meanwhile another doctor in the same hospital uses completely different medications.

deann52 · Oct 31, 2011

In outpatient surgery they use it along with Versed to calm patients before using propofol. I have had it for surgery, good stuff

RedCell · Nov 1, 2011

Ketamine is an excellent drug with outstanding analgesic, amnestic and sedative capabilities. The trick is to avoid the dissociative effects if benzodiazepines are not being administered. I use it quite frequently on my patients, especially the ones who associate a bottle of oxycodone with a Pez dispenser. I think you will probably be seeing it used much more in the ICU setting now that fentanyl is on a national shortage.