jueves, 11 de noviembre de 2010

Ketamina en urgencias



 

----- Mensaje reenviado ----
De: Victor Whizar-Lugo <vwhizar@anestesia-dolor.org>
Para: maximocuadros@yahoo.es
Enviado: jue,11 noviembre, 2010 17:12
Asunto: Ketamina en urgencias

XLIV Congreso Mexicano de Anestesiologia

Anestesia y Medicina del Dolor
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No:242     

Noviembre 11, 2010
 Tradiciones

Estimad@ Maximo Jesus Cuadros Chavez:

 

 

Auditoría de la seguridad y la eficacia de la ketamina para la sedación de procedimientos en el servicio de urgencias

Audit of the safety and effectiveness of ketamine for procedural sedation in the emergency department
J M Vardy, N Dignon, N Mukherjee, D M Sami, G Balachandran, S Taylor.
Emerg Med J 2008;25:579-582   doi:10.1136/emj.2007.056200

 

Abstract
Aim: To examine the effectiveness and safety of the sedative agents used in the emergency department following the introduction of ketamine as an agent for procedural sedation. Methods: A 2-year prospective audit of sedation practice was undertaken. This specifically examined the rationale behind a doctor's choice of sedative agent, the depth of sedation achieved, adverse events and the time taken to regain full orientation. Results: 210 patients were included of whom 85 (40%) were given ketamine, 107 (51%) midazolam and 18 (9%) propofol. The median time to full orientation was 25 min for ketamine, 30 min for midazolam and 10 min for propofol. Complications occurred in 15.9% of sedations overall (14.6% of those given ketamine, 15.8% given midazolam and 22.2% given propofol). Apnoea and hypoxia most often occurred with midazolam and propofol, while hypertension and hypertonicity were encountered more frequently with ketamine. In addition, 19.5% of patients given ketamine suffered the re-emergence phenomenon. The association between deep sedation with no response to pain and adverse events encountered with midazolam does not occur with ketamine.  Conclusions: Ketamine is both safe and effective and compares favourably with midazolam as an agent for procedural sedation in the emergency department. Although the re-emergence phenomenon occurred, no psychological sequelae were encountered after return to full orientation. Ketamine may be particularly useful in groups of patients at high risk of adverse effects with midazolam

 

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