Mankowitz Scott L, Regenberg Pat, Kaldan Janina, Cole Jon B
Emergency Department, Overlook Medical Center, Summit, New Jersey.
Medical Library, Overlook Medical Center, Summit, New Jersey.
J Emerg Med. 2018 Nov;55(5):670-681. doi: 10.1016/j.jemermed.2018.07.017. Epub 2018 Sep 7.
Rapid tranquilization of agitated patients can prevent injuries and expedite care. Whereas antipsychotics and benzodiazepines are commonly used for this purpose, ketamine has been suggested as an alternative.
The aim of this systematic review is to determine the safety and effectiveness of ketamine to sedate prehospital and emergency department (ED) patients with undifferentiated agitation.
Studies and case series of patients receiving ketamine for agitation were included. Studies were excluded if ketamine was used for analgesia, procedural sedation, asthma, or induction. Information sources included traditional and gray literature.
The initial search yielded 1176 results from 14 databases. After review of titles and abstracts, 32 studies were reviewed and 18 were included in the analysis, representing 650 patient encounters. The mean dose of ketamine was 315 mg (SD 52) given intramuscularly, with adequate sedation achieved in 7.2 min (SD 6.2, range 2-500). Intubation occurred in 30.5% of patients (95% confidence interval [CI] 27.0-34.1%). In the majority of those patients, ketamine was administered by paramedics during ground transport and the patient was intubated on ED arrival. When ketamine was administered in the ED, the intubation rate was 1.8% (95% CI 0.0-4.4%); in air medical transport, the rate was 4.9% (95% CI 0.0-10.3%). Other reported side effects included: vomiting, 5.2% (2.3-8.1%); hypertension, 12.1% (5.7-18.6%); emergence reactions, 3.5% (1.4-5.6%); transient hypoxia, 1.8% (0.1-3.6%) and laryngospasm, 1.3% (0.3-2.3%).
Ketamine provides rapid sedation for undifferentiated agitated patients and is associated with higher intubation rates when used by ground Emergency Medical Services paramedics, compared with ED or air medical transport patients. Other side effects are common but usually self-limiting.
快速使躁动患者镇静可预防受伤并加快治疗。虽然抗精神病药物和苯二氮䓬类药物常用于此目的，但氯胺酮已被提议作为一种替代药物。
本系统评价的目的是确定氯胺酮用于院前和急诊科（ED）未分化躁动患者镇静的安全性和有效性。
纳入接受氯胺酮治疗躁动患者的研究和病例系列。如果氯胺酮用于镇痛、程序性镇静、哮喘或诱导，则排除该研究。信息来源包括传统文献和灰色文献。
初步检索从14个数据库中获得1176条结果。在审查标题和摘要后，对32项研究进行了审查，18项纳入分析，代表650例患者就诊。氯胺酮的平均剂量为315mg（标准差52），经肌肉注射给药，7.2分钟（标准差6.2，范围2 - 500）内实现充分镇静。30.5%的患者发生插管（95%置信区间[CI]27.0 - 34.1%）。在这些患者中，大多数患者在地面转运期间由护理人员给予氯胺酮，并在到达急诊科时进行插管。当在急诊科给予氯胺酮时，插管率为1.8%（95%CI 0.0 - 4.4%）；在航空医疗转运中，插管率为4.9%（95%CI 0.0 - 10.3%）。其他报告的副作用包括：呕吐，5.2%（2.3 - 8.1%）；高血压，12.1%（5.7 - 18.6%）；苏醒反应，3.5%（1.4 - 5.
