# Medical Uses of Ketamine?



## GO!!! (28 May 2005)

Just a quick question for the medics in the crowd;

Is it true that the cat sedative/club drug "ketamine" (aka Special K) is used in the CF for medical or dental surgeries?

If so, why?


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## Donut (28 May 2005)

Ketamine is making a comeback in some medical fields, I can't speak to it being in the CF formulary of Rx drugs, but I've transported several patients who have had it administered to them for pre-op sedation.

It has a property of not depressing respirations or blood pressure (going off memory here, I'm not pulling out a CPS), and is therefore useful in some cases.

I do know that several field amputations (for patients trapped in debris that could not be moved) at the OK city bombing were conducted with Ketamine as the principle sedative, due to these properties.

An anesthesiologist of my acquintance once pointed out that any patient will let you use ketamine on them, once.  The hallucinations and dreams while under are reportedly horrific, but I've got very limited experience with the drug.  

Perhaps RN PRN or one of the NO on here can provide more info.

DF


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## medicineman (30 May 2005)

I seem to recall that Ketamine is still in the battlebox - it was there when I was in Kabul in 03 and Haiti last year and has been there as long as I can remember.  As mentioned before it doesn't depress respirations like other sedative agents and narcotics.

MM


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## starlight_745 (30 May 2005)

It is often used inconjunction with other induction agents as a sedative.  Some docs love it others are leary of it.  I have seen many emerg physicians in my area use it to perform conscious sedations in the ER for procedures like Colles fracture reductions and reducing shoulder dislocations.  Often it is used with propafol (which can give you nice erotic dreams).  Some physicians use it to perform sedation for intubation as well which is probably why its in the battle box.


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## Fraser.g (30 May 2005)

It is quite common for conscious sedation along with Versaid (medasolam) in children up to 13 years of age. After that the night frights and hallucinations are extreme. In adults the ER Docs I work with will usually go for Versiad and propofol instead. The down side of the later is the danger of a compremised airway.

Last night I helped reduce a Radial green stick fracture on a 33 Kg girl with 3 mg of Versaid and 25 ug of Ketamine. Worked like a charm.

I can see why it would still be in the battle box. When push came to shove you can use it and deal with the hallucinations after.

To address GO!s original question, 
We use it for the same reason that it is abused on the street as Special K. It does not compremise the airway and we have to do things in the ER that it is better if the patient does not remember us doing like pushing down on broken bones or popping a shoulder back into place with brute force.


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## GO!!! (30 May 2005)

Thank you for the info, and now, for my next question;

If one were to be administered Ketamine for a dental surgery, and subsequently attack members of the dental clinic and parts of the clinic itself in a drug induced rage, requiring restraints and sedation, (I'm 6'3'' 225lbs) would it be a wise idea for that person to get a medic alert bracelet? The medics on scene said "no".

Lets just say I want a second opinion.

Is this reaction "normal" or should it be avoided with a medic alert bracelet? 

Thank you for your informative answers thus far.


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## Fraser.g (30 May 2005)

Yours does not sound like an allergic reaction to Ketamine but more of a sensitivity. I would be nice to warn the medics in the future but with the limited information given I do not think a medical alert bracelet is warrented. Of course seek out the MO on your next visit to the MIR for a professional opinion and review of your specific case.


GF

Modification to add link for informaiton on Ketamine
http://www.nda.ox.ac.uk/wfsa/html/u04/u04_010.htm#acti


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## old medic (30 May 2005)

I will concur with RN_PRN about the medic alert bracelet. 

You should ask the dental clinic and the MIR about noting the bad experience with the drug 
on your dental and medical files. It's a safe bet it's already on your dental file.


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## GO!!! (30 May 2005)

So I don't have to worry about being administered Ketamine in an emergency situation?

Thats what I'm concerned about.


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## brin11 (30 May 2005)

Curious if you see limb rigidity in humans with Ketamine?  This is a side effect we see in animals.


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## Fraser.g (30 May 2005)

Ref: http://www.nda.ox.ac.uk/wfsa/html/u04/u04_010.htm#acti

Skeletal muscle
Muscle tone is often increased. Spontaneous movements may occur during anaesthesia but reflex response to surgery is uncommon if the patient is adequately anaesthetised.


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## brin11 (31 May 2005)

Thanks for the info RN PRN.


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## medic65726 (14 Jun 2005)

Due to it's sympathomimetic effects Ketamine could cause increased muscle tone. It is a dissociative aneasthetic and is used in many forums, not just pediatrics. We routinely use it when intubating patients in Status Asthmatics as it has bronchodilatory effects. The hallucinations are rare, more common in children than adults, and easily dealt with by pre-medicating with a little Versed. I find it is also helpful to give some Atropine as well, as Ketamine can cause increased secretions, further complicating airway management.
Recently I've even seen it used for prolonged sedation of ventilated patients in an ICU setting as well. Generally there seems to be quite a resugence of Ketamine use.
Personlly I love using it, when appropriate, to induce general aesthesia for intubation as it does not effect respiratory effort, and can even transiently increase blood pressure.
Elected to use it the other night, while trying to keep sedated, a patient with massive stab wounds to the chest, who, hemodyanmically was very unstable (heart rate 140 and BP 60/P).
Just my 2 cents.


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## brin11 (14 Jun 2005)

Thanks Medic for the info.  Just curious as I mentioned before that it causes pronounced limb rigidity in animals to the point that they look like they have tetanus.  We usually use a 1:1 of Ketamine and valium.  Do you always use atropine or glycopyrolate as well as it doesn't cross the BBB?


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## medic65726 (14 Jun 2005)

Very good question about the limb rigity. I've never seen it in humans, but can guess as the mechanism (can go to the CPS if you want).
I generally only use a small dose of versed, to act as an amnestic (2-4mg), but only if thier blood pressure can handle it.
If using Ketamine as an induction agent I try to use always use Atropine, but unfortuately we don't carry glycopyrrolate.
We have a number of agents available to us, but don't carry the full gamut of anesthetics.
As sedative/induction/paralytic agents go, we generally carry: Fentanyl, Versed, Propofol, Ketamine, Vecuronium, Rocuronium, Succinycholine, and will sometimes get our hands on Thiopental. We usualy use Fentanyl/Versed/Succinycholine for Inductions, but will use others depending on the situation. Propofol on it's own is one of my preferred ways.


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## brin11 (14 Jun 2005)

Medic,  

I agree with you regarding induction with propofol.  An excellent anesthetic and extremely short acting.  Do you see apnea very often?


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## medic65726 (15 Jun 2005)

hmmm, good question. I don't recall often seeing apnea, although once I've put them on the ventilator, I don't really care and as soon as they are relaxed enough they'd be intubated so I wouldn't wait long enough to see them apneic.
I suppose post induction when they are on a Propofol infusion their respiratory effort might be somewhat reduced.
Propofol infusions are nice for transport as the Neurosurgeons can shut it off and quickly see how the patient responds. Although I used to tell them when they freaked out about us just having heavily sedated and paralyzed someone, shortly before we got there, was just send them for the CT scan now. They are gonna get scanned anyway and by the time the scan is done, they are waking up (as much as they are going to). Propofol (milk of amnesia) alone is a wonderful tool, even on it's own.


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## nsmedicman (1 Nov 2005)

I have seen Ketamine used in the ED, but usually piggy-backed with something else (ROC, Versed, Fentanyl). Anytime I have seen it used, it has had an excellent outcome.


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## Adam (11 Nov 2005)

all our conscious sedation's are done with Ketamine here in Kashmir.


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