Isbister Geoffrey Kennedy, Calver Leonie A, Downes Michael A, Page Colin B
Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia; Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
Clinical Toxicology Research Group, University of Newcastle, Newcastle, New South Wales, Australia.
Ann Emerg Med. 2016 May;67(5):581-587.e1. doi: 10.1016/j.annemergmed.2015.11.028. Epub 2016 Feb 18.
We investigate the effectiveness and safety of ketamine to sedate patients with severe acute behavioral disturbance who have failed previous attempts at sedation.
This was a prospective study of patients given ketamine for sedation who had failed previous sedation attempts. Patients with severe acute behavioral disturbance requiring parenteral sedation were treated with a standardized sedation protocol including droperidol. Demographics, drug dose, observations, and adverse effects were recorded. The primary outcome was the number of patients who failed to sedate within 120 minutes of ketamine administration or requiring further sedation within 1 hour.
Forty-nine patients from 2 hospitals were administered rescue ketamine during 27 months; median age was 37 years (range 20-82 years); 28 were men. Police were involved with 20 patients. Previous sedation included droperidol (10 mg; 1), droperidol (10+10 mg; 33), droperidol (10+10+5 mg; 1), droperidol (10+10+10 mg; 11), and combinations of droperidol and benzodiazepines (2) and midazolam alone (1). The median dose of ketamine was 300 mg (range 50 to 500 mg). Five patients (10%; 95% confidence interval 4% to 23%) were not sedated within 120 minutes or required additional sedation within 1 hour. Four of 5 patients received 200 mg or less. Median time to sedation postketamine was 20 minutes (interquartile range 10 to 30 minutes; 2 to 500 minutes). Three patients (6%) had adverse effects, 2 had vomiting, and a third had a transient oxygen desaturation to 90% after ketamine that responded to oxygen.
Ketamine appeared effective and did not cause obvious harm in this small sample and is a potential option for patients who have failed previous attempts at sedation. A dose of 4 to 5 mg/kg is suggested, and doses less than 200 mg are associated with treatment failure.
我们研究氯胺酮用于镇静先前镇静尝试失败的严重急性行为障碍患者的有效性和安全性。
这是一项对先前镇静尝试失败后接受氯胺酮镇静的患者的前瞻性研究。需要胃肠外镇静的严重急性行为障碍患者采用包括氟哌利多在内的标准化镇静方案进行治疗。记录人口统计学资料、药物剂量、观察结果和不良反应。主要结局是在氯胺酮给药后120分钟内未实现镇静或在1小时内需要进一步镇静的患者数量。
在27个月期间，来自2家医院的49例患者接受了挽救性氯胺酮治疗；中位年龄为37岁（范围20 - 82岁）；28例为男性。20例患者有警方介入。先前的镇静包括氟哌利多（10毫克；1例）、氟哌利多（10 + 10毫克；33例）、氟哌利多（10 + 10 + 5毫克；1例）、氟哌利多（10 + 10 + 10毫克；11例），以及氟哌利多与苯二氮䓬类药物的联合使用（2例）和单独使用咪达唑仑（1例）。氯胺酮的中位剂量为300毫克（范围50至500毫克）。5例患者（10%；95%置信区间4%至23%）在120分钟内未实现镇静或在1小时内需要额外镇静。5例患者中有4例接受的剂量为200毫克或更少。氯胺酮给药后达到镇静的中位时间为20分钟（四分位间距10至30分钟；2至500分钟）。3例患者（6%）出现不良反应，2例呕吐，第3例在氯胺酮给药后出现短暂的氧饱和度降至90%，吸氧后恢复。
在这个小样本中，氯胺酮似乎有效且未造成明显伤害，对于先前镇静尝试失败的患者是一个潜在的选择。建议剂量为4至5毫克/千克，剂量小于200毫克与治疗失败相关。
