Procedural sedation consists of administering sedatives (i.e. midazolam, etomidate, propofol) or dissociative agents (i.e. ketamine) with or without opioid analgesics such as morphine and fentanyl.
The widespread use of ketamine for procedural sedation may be limited by physician concern about unpleasant, vivid dreaming, hallucinations, and reactions after its administration known as recovery agitation. This has been found to occur in 12 percent of cases and is seen less often in youth.
In some instances, ketamine might be considered more ideal than other procedural sedation agents because it provides sedation, analgesia, and an amnestic-like dissociation between mind and body.
Recent studies have shown that administering ketamine with a benzodiazepine such as midazolam significantly reduces the incidence of recovery agitation following procedural sedation; this alternative might therefore be considered when appropriate.
References
Sener et al. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. Vol. 57. No. 2. February 2011.
