The Myths of Uncontrolled Emergence Reactions and Consideration to Stop Mandatory, Protocolled Midazolam...

Area of Science:

• Emergency Medicine
• Pharmacology
• Prehospital Care

Background:

• Ketamine is widely used in prehospital settings.
• Concerns about ketamine-induced behavioral disturbances persist, leading to routine co-administration with midazolam.
• Benzodiazepines carry risks of significant morbidity and mortality.

Purpose of the Study:

• To address persistent myths regarding ketamine's safety in prehospital environments.
• To evaluate the risks associated with co-administering midazolam with ketamine.
• To provide evidence-based recommendations for managing ketamine-related side effects.

Main Methods:

• Review of existing literature on ketamine use in austere environments.
• Analysis of adverse event data related to ketamine and benzodiazepine co-administration.
• Evidence-based discussion of ketamine's pharmacodynamics and clinical effects.

Main Results:

• Myths regarding frequent behavioral disturbances with ketamine are not supported by evidence.
• Co-administration of midazolam poses significant risks and should be avoided unless clinically indicated.
• Agitation and altered mental status (AMS) are less likely with higher ketamine doses.

Conclusions:

• Ketamine is a safe and effective agent in prehospital care.
• Midazolam co-administration should be reserved for specific indications due to potential harm.
• Increased ketamine dosage is the preferred treatment for "incomplete dissociation" rather than adding benzodiazepines.