Although still considered a nontraditional sedative in critical care units, ketamine is being used more regularly as an opioid alternative for pain control and sedation.

Ketamine was approved as an anesthetic nearly 50 years ago, and the number of off-label uses for the drug in clinical settings has grown significantly over the last decade, primarily due to concerns about dependence and respiratory depression associated with traditional sedatives, such as opioids and benzodiazepines.

“Ketamine Use in the Intensive Care Unit” reviews practical considerations for use of ketamine in critical care, including its most common uses as an analgesic, as well as during rapid sequence intubation and procedural sedation.

The article is published as the Drug Update column in the summer 2018 issue of AACN Advanced Critical Care. This column is a regular feature that focuses on medications used in critical care.

“The entire critical care team must be familiar with the various off-label applications and dosing strategies of ketamine,” said coauthor Sarah Nelson, PharmD, BCPS, BCCCP, clinical pharmacist, and critical care specialist in the Department of Pharmacy at Mayo Clinic, Rochester, Minnesota. “With ketamine use becoming more common, nurses and other caregivers need to understand its unique characteristics and how it might affect patients.”

Properties that make ketamine a desirable sedative for a variety of procedures in the ICU include the following:

•Quick onset of action and short duration of action may be especially useful for short, painful procedures.
•Trance-like sedation may aid patients in not remembering painful or difficult procedures.
•Additional pain control may allow for reduced opioid requirements.
•Effects on breathing may help avoid the need for invasive respiratory support.

Although ketamine has demonstrated safety when used for off-label indications, the authors note that monitoring for respiratory depression and adverse drug effects should be routine.

Studies have found that approximately 20% of patients may experience severe agitation as they recover from sedation, including disorientation, strange dreams, and hallucinations. Despite ketamine’s benefits relative to other sedatives, this emergence phenomenon during recovery from sedation is a significant reason its use is not more widespread.

—Newswise