Introduction:

Rapid recovery and low cost are among the benefits of ketamine for emergency sedation. It has been excluded as the first choice because of the associated adverse events.

Objective:

To describe the adverse events associated with the use of ketamine in a high-complexity emergency service.

Materials and methods:

Review of clinical records of patients who received sedation with ketamine for orthopedic procedures in the emergency room between January 2012 and June 2015, with identification of adverse events.

Results:

Overall, 354 patients were identified (74% males, 32% children), with a median age of 21 years, interquartile range (IQR) of 20 years. Of them, 66% had upper limb injuries, 79% were treated on an outpatient basis, with a median length of stay in the emergency service of 3.6hours (IQR 2,5). In 98%, sedation was given by a different practitioner from the orthopedic surgeon. Ketamine and midazolam were administered together in the same proportion, and 3 or more medications were used in 13% of cases. Overall, 14 adverse events (3.9%) were described, 9 related to desaturation between 80% and 90% which was solved with oxygen through nasal cannula, 3 were cases of vomiting following sedation with no aspiration, and 2 were cases of desaturation <80% which were managed with oxygen administration through a cannula and maneuvers to maintain airway patency. One patient had visual hallucinations. No patient required advanced airway maneuvers.

Conclusion:

The use of ketamine for sedation in the emergency service is associated with a low prevalence of major adverse events. Sedation with ketamine and midazolam appears to be a safe strategy for these procedures.

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