A Novel Agent for Management of Agitated Delirium: A Case Series of Ketamine Utilization in the Pediatric Emergency Department

Abstract Control of the agitated patient in the emergency department is challenging. Many options exist for chemical sedation, but most have suboptimal pharmacodynamic action, and many have undesirable adverse effects. There are reports of ketamine administration for control of agitation prehospital and in traumatically injured patients. Ketamine is a noncompetitive N-methyl-D-aspartic acid receptor antagonist, making it an effective dissociative agent. We present 5 cases of ketamine administration to manage agitated adolescent patients with underlying psychiatric disease and/or drug intoxication. Ketamine, as a dissociative agent, may be an alternative pharmacological consideration for the control of agitation in patients with undifferentiated agitated delirium.

[1]  R. Chait,et al.  Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients , 2014, The western journal of emergency medicine.

[2]  L. Marzullo.  Pharmacologic Management of the Agitated Child , 2014, Pediatric emergency care.

[3]  S. Silvers,et al.  Clinical policy: procedural sedation and analgesia in the emergency department. , 2005, Annals of emergency medicine.

[4]  P. Nystrom,et al.  Successful Management of Excited Delirium Syndrome with Prehospital Ketamine: Two Case Examples , 2013, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[5]  M. Auerbach,et al.  Ketamine, Propofol, and Ketofol Use for Pediatric Sedation , 2012, Pediatric emergency care.

[6]  D. Mash,et al.  Excited Delirium Syndrome (ExDS): defining based on a review of the literature. , 2012, The Journal of emergency medicine.

[7]  Donald H. Arnold,et al.  Ketamine sedation is not associated with clinically meaningful elevation of intraocular pressure. , 2012, The American journal of emergency medicine.

[8]  J. Machan,et al.  Intranasal Ketamine for Procedural Sedation in Pediatric Laceration Repair: A Preliminary Report , 2012, Pediatric emergency care.

[9]  R. Frascone,et al.  Laryngospasm and Hypoxia After Intramuscular Administration of Ketamine to a Patient in Excited Delirium , 2012, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[10]  G. Vilke,et al.  Excited delirium syndrome (ExDS): treatment options and considerations. , 2012, Journal of forensic and legal medicine.

[11]  S. Campbell,et al.  Ketamine in Adult Emergency Medicine: Controversies and Recent Advances , 2011, The Annals of pharmacotherapy.

[12]  E. Hunter,et al.  Ketamine sedation for patients with acute agitation and psychiatric illness requiring aeromedical retrieval , 2011, Emergency Medicine Journal.

[13]  Baruch Krauss,et al.  Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. , 2011, Annals of emergency medicine.

[14]  N. Iacovidou,et al.  Pharmacological Aspects and Potential New Clinical Applications of Ketamine: Reevaluation of an Old Drug , 2009, Journal of clinical pharmacology.

[15]  R. Bachur,et al.  Serious Adverse Events During Procedural Sedation With Ketamine , 2009, Pediatric emergency care.

[16]  G. Lin,et al.  The combative multitrauma patient: a protocol for prehospital management , 2007, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[17]  J. Clinton,et al.  DISCONTINUATION OF DROPERIDOL FOR THE CONTROL OF ACUTELY AGITATED OUT-OF-HOSPITAL PATIENTS , 2005, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[18]  A. Camm,et al.  Drug induced QT prolongation and torsades de pointes , 2003, Heart.

[19]  N. Trieger,et al.  Paradoxical reactions to benzodiazepines in intravenous sedation: a report of 2 cases and review of the literature. , 2002, Anesthesia progress.

[20]  G. Geeting,et al.  Intramuscular ketamine for the rapid tranquilization of the uncontrollable, violent, and dangerous adult patient. , 2001, The Journal of trauma.

[21]  D. Blazys.  Violence in the emergency department. , 2001, Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association.

[22]  S. Rothrock,et al.  Inadvertent ketamine overdose in children: clinical manifestations and outcome. , 1999, Annals of emergency medicine.

[23]  S. Rothrock,et al.  Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. , 1998, Annals of emergency medicine.

[24]  L. Goldfrank.  Medical toxicology. , 1992, JAMA.

[25]  N. Levy,et al.  Ketamine and Intraocular Pressure in Children , 1976, Anesthesia and analgesia.

[26]  S Kamen,et al.  The task force. , 1976, Journal of hospital dental practice.