Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina.
South Carolina College of Pharmacy, Columbia, South Carolina.
Pharmacotherapy. 2018 Jan;38(1):139-151. doi: 10.1002/phar.2060. Epub 2017 Dec 22.
Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting. A literature review was conducted to identify articles utilizing ketamine in the prehospital setting. The review was limited to English-language articles identified in Embase (1988-June 2017) and the U.S. National Library of Medicine (1970-June 2017). References of all pertinent articles were also reviewed. Ten articles were identified including 418 patients receiving ketamine for agitation. The most commonly utilized route for administration was intramuscular (IM), with five of the seven IM administration studies using a ketamine dose of 5 mg/kg. Ketamine administered in this fashion was efficacious to achieve proper sedation during transport and did not require repeat dosing. Three studies applied a ketamine protocol to outline dosing and the management of ketamine adverse events. The most common adverse events identified were respiratory-related events and hypersalivation. Ketamine has a role for agitation management in the prehospital setting; however, emergency personnel education and ketamine protocols should be utilized to aid in safe and effective pharmacotherapy and provide guidance on the management of adverse events. Future prospective comparative studies, with protocolized standard ketamine regimens, are needed to further delineate the role of ketamine in agitation management and identify accurate adverse event incidence rates.
传统的院前治疗急性激越患者的一线疗法包括抗精神病药联合苯二氮䓬类药物。最近，人们对氯胺酮在院前环境中的应用越来越感兴趣，试图克服传统药物的局限性，提供更安全有效的治疗方法。本文综述了氯胺酮的药理学，评估了氯胺酮用于院前激越的文献，并提出了一个可能在院前环境中使用的算法。
进行了文献复习，以确定在院前环境中使用氯胺酮的文章。综述仅限于在 Embase（1988 年至 2017 年 6 月）和美国国家医学图书馆（1970 年至 2017 年 6 月）中确定的英语文章。还审查了所有相关文章的参考文献。
确定了 10 篇文章，包括 418 例接受氯胺酮治疗激越的患者。最常用的给药途径是肌肉注射（IM），7 项 IM 给药研究中有 5 项使用 5mg/kg 的氯胺酮剂量。以这种方式给予的氯胺酮在转运过程中达到适当镇静的效果，并无需重复给药。三项研究应用氯胺酮方案来概述剂量和氯胺酮不良反应的管理。最常见的不良反应是与呼吸有关的事件和过度流涎。
氯胺酮在院前环境中可用于治疗激越；然而，应使用急救人员教育和氯胺酮方案，以帮助安全有效的药物治疗，并提供关于不良反应管理的指导。需要进一步前瞻性比较研究，制定标准化的氯胺酮方案，以进一步阐明氯胺酮在激越管理中的作用，并确定准确的不良反应发生率。
