Title: Ketamine is Not Without Risk<br/>Author: Mike Winters<br/><a href='http://umem.org/profiles/faculty/141/'>[Click to email author]</a><hr/><p> <strong><u>DSI, Ketamine, and Apnea</u></strong></p> <ul> <li> In recent years, delayed sequence intubation (DSI) with ketamine has been used in select patients to maximize preoxygenation and dinitrogenation. </li> <li> Importantly, DSI is not well studied. In the only prospective trial of DSI, patients received approximately 1.4 mg/kg of ketamine.</li> <li> Driver, et al. report the abrupt onset of apnea in a patient who received a much lower dose of ketamine (25 mg) for DSI.</li> <li> <strong>Take Home Point: If DSI is a part of your preoxygenation armamentarium, apnea can occur even at low doses of ketamine. Stand at the patient's bedside and be ready to immediately intubate the patient.</strong></li> </ul> <fieldset><legend>References</legend>
<p> Driver BE, Reardon RF. Apnea after low-dose ketamine sedation during attempted delayed sequence intubation. <em>Ann Emerg Med </em>2017; 69:34-35.</p> </fieldset>