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Ketamine for analgosedation in critically ill patients
Brian L Erstad1, Asad E Patanwala1
1Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, 1295 N Martin Ave, PO Box 210202, Tucson, AZ, USA.
Journal of Critical Care
|August 3, 2016
Summary
Intravenous ketamine offers unique analgosedative benefits for critically ill adults, preserving respiratory reflexes and stimulating the sympathetic nervous system. This review provides guidance for its clinical use in intensive care settings.
Area of Science:
- Pharmacology
- Critical Care Medicine
Background:
- Ketamine's primary mechanism involves N-methyl-d-aspartate receptor blockade.
- Its lipophilicity leads to a large volume of distribution and potential accumulation with infusions.
Purpose of the Study:
- To offer practical guidance for clinicians on using intravenous ketamine for analgosedation in critically ill adult patients.
- To review the analgosedative properties of ketamine in intensive care unit (ICU) settings.
Main Methods:
- A narrative review of articles retrieved from MEDLINE (inception to January 2016).
- Focus on pharmacological properties, pharmacokinetics, dosing, adverse effects, and outcomes of ketamine.
Main Results:
- Ketamine preserves protective airway reflexes, improves lung compliance, and causes less respiratory depression than conventional sedatives.
- It induces sympathetic stimulation, unlike other sedatives/analgesics.
- Psychotomimetic effects are a concern, potentially contributing to delirium.
Conclusions:
- Ketamine's unique pharmacological profile makes it an attractive alternative to traditional agents like opioids for analgosedation in the ICU.
- Dosing and monitoring recommendations are provided.