Strayer Reuben J, Nelson Lewis S
Emergency Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
Am J Emerg Med. 2008 Nov;26(9):985-1028. doi: 10.1016/j.ajem.2007.12.005.
Ketamine is widely used as a procedural sedation agent in pediatrics, where its safety and efficacy are supported by numerous studies. Emergency physicians use ketamine infrequently in adults, as it is believed to have a more significant side effect profile in this population. However, adult data on ketamine use in the emergency medicine literature are sparse. Our objective was to determine ketamine's adverse effect profile in adults when used for procedural sedation.
We performed a literature review based on adverse effect research methodology recommendations. PubMed, EMBASE, TOXNET, and a variety of specialized databases were queried without regard to publication date or language. Experts were contacted to locate additional data. Inclusion criteria included adult study; ketamine used to facilitate the performance of painful procedures; dose of at least 1 mg/kg intravenous or at least 2 mg/kg intramuscular; original data and adverse events reported; spontaneously breathing patient, and no continuous cotherapies. Studies that met inclusion criteria were abstracted onto structured forms and their results qualitatively summarized.
Of the 5512 unique citations that were evaluated, 87 met criteria for inclusion. Most studies were performed in the 1970s and published in the anesthesia literature. Contexts, end points, and methodological quality varied widely across studies. Ketamine reliably produces conditions that facilitate the performance of painful procedures. Pharyngeal reflexes are generally preserved and cardiovascular tone stimulated, including a rise in blood pressure and myocardial oxygen demand. Laryngospasm and airway obstruction are reported, and though ketamine is a respiratory stimulant, a brief period of apnea around the time of injection is common. Reports of significant cardiorespiratory adverse events are rare, despite ketamine's frequent use in austere, poorly monitored settings. Dysphoric emergence phenomena occur in 10% to 20% of cases; sedating medications are effective in preventing and managing these reactions.
When ketamine is used for procedural sedation in adults, emergence phenomena occur in 10% to 20% of patients. Although providers must be prepared to recognize and manage airway obstruction, cardiorespiratory adverse events are rare and typically do not affect outcomes.
氯胺酮在儿科作为一种操作镇静剂被广泛使用，大量研究证实了其安全性和有效性。急诊医生在成人中很少使用氯胺酮，因为人们认为它在这一人群中具有更显著的副作用。然而，急诊医学文献中关于成人使用氯胺酮的数据很少。我们的目的是确定氯胺酮用于成人操作镇静时的不良反应情况。
我们根据不良反应研究方法建议进行了文献综述。对PubMed、EMBASE、TOXNET以及各种专业数据库进行了检索，不考虑出版日期或语言。联系了专家以获取更多数据。纳入标准包括成人研究；使用氯胺酮以促进痛苦操作的进行；静脉注射剂量至少为1mg/kg或肌肉注射剂量至少为2mg/kg；报告原始数据和不良事件；自主呼吸患者，且无持续联合治疗。符合纳入标准的研究被提取到结构化表格中，并对其结果进行定性总结。
在评估的5512条独特引文中，87条符合纳入标准。大多数研究在20世纪70年代进行，并发表在麻醉学文献中。不同研究的背景、终点和方法学质量差异很大。氯胺酮确实能产生有利于进行痛苦操作的条件。咽反射通常得以保留，心血管张力受到刺激，包括血压升高和心肌需氧量增加。有喉痉挛和气道阻塞的报告，尽管氯胺酮是一种呼吸兴奋剂，但注射时短暂的呼吸暂停很常见。尽管氯胺酮经常在条件简陋、监测不足的环境中使用，但严重心肺不良事件的报告很少。10%至20%的病例会出现烦躁不安的苏醒现象；镇静药物对预防和处理这些反应有效。
当氯胺酮用于成人操作镇静时，10%至20%的患者会出现苏醒现象。尽管医护人员必须准备好识别和处理气道阻塞，但心肺不良事件很少见，通常不会影响治疗结果。
