NUBE 2025

Ketamine has a well-established efficacy and safety profile when used as an anesthetic agent in surgical procedures in both adults and minors. Ketamine use is being expanded to include other indications such as acute and chronic pain, complex alcohol withdrawal and alcohol use disorder, opioid use disorder, depression, and suicidality, with promising findings. Ketamine was also found to have rapid sedative effects when given to treat severe psychomotor agitation in pre-ER and ER settings, often via the intramuscular route. When it comes to severe agitation in a patient with borderline low blood pressure, heart rate, and respiration rate, almost all sedative agents, including antipsychotics, benzodiazepines, a1 antagonists, a2 agonists, and dexmedetomidine would further jeopardize the fragile vitals and may result in respiratory depression. In addition, most of these agents’ clinical effects peak after 20 to 30 minutes of administration via the intramuscular route, which can be a long time while attempting to maintain the safety of the patient, staff, and others. Ketamine, on the other hand, is found to be less likely to lead to further hemodynamic instability or respiratory depression. Additionally, the time needed to induce sedation is consistently found to be shorter when ketamine is used compared to other agents in several head-to-head clinical trials.

In this presentation, we will quickly review the mechanism of action of ketamine and discuss its indication in psychomotor agitation in pre-ER and ER settings. We will also review its efficacy and safety profile and best practices after administration.

Learning Objectives:

Understand ketamine role in treating psychomotor agitation in pre-ER and ER settings.

Explain the advantages of using ketamine in this context compared to other agents.

Appreciate best practices of medical care following ketamine use for agitation.