Ketamine has become a popular agent in the ED for both RSI and procedural sedation.
Given the sedative, analgesic, dissociative, antidepressant, and anti-inflammatory properties, ketamine has also been used in a number of other critical illness conditions including:
Acute pain management
Status asthmaticus
Alcohol withdrawal syndrome
Status epilepticus
Acute agitated delirium
The authors of a recent review in Critical Care Medicine found that the evidence supporting the use of ketamine in the critically ill is most robust for adjunctive analgesia in the intubated patient. Surprisingly, the data is very limited to support the use of ketamine in these other conditions.
Pearl: ketamine does have a myocardial depressant effect, which can be unmasked in states of catecholamine depletion and result in hypotension and bradycadia.
References
Hurth KP, et al. The reemergence of ketamine for treatment in critically ill adults. Crit Care Med. 2020; 48:899-911.
