ICUs Using Ketamine More Regularly as Alternative to Opioids

Drug Update column in AACN Advanced Critical Care journal reviews most common uses of ketamine in critical care


Newswise — 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 co-author 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 percent 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.

AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles and columns of interest to critical and progressive care clinicians.

Access the issue by visiting the AACN Advanced Critical Care website at http://acc.aacnjournals.org/.

 

About AACN Advanced Critical Care: AACN Advanced Critical Care is a quarterly, peer-reviewed publication with in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. An official publication of the American Association of Critical-Care Nurses, the journal has a circulation of 4,845 and can be accessed at http://acc.aacnjournals.org/.

About the American Association of Critical-Care Nurses: Founded in 1969 and based in Aliso Viejo, California, the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world. AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the U.S. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution.

American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656-4109; 949-362-2000 www.aacn.org; facebook.com/aacnface; twitter.com/aacnme

 

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