Ketamine has established itself as a valuable dissociative agent for procedural sedation in medical settings, offering advantages due to its anesthetic and analgesic properties. Originally developed as an anesthetic in the 1960s, it effectively provides sedation while preserving airway reflexes and cardiorespiratory function, making it particularly suitable for various clinical procedures in both adults and pediatric patients (Zaki et al., 2023; Afify et al., 2023).
In emergency medicine, ketamine is often used to facilitate painful procedures without necessitating complete anesthesia. This is achieved through its ability to induce a dissociative state, which is characterized by a sense of detachment from the environment and a reduction in pain perception (Zaki et al., 2023; (Javid et al., 2015; (Goddard et al., 2021; . The dosages for procedural sedation typically range from 0.25 mg/kg to 1 mg/kg, with the flexibility to adjust based on the specific clinical context or the concurrent use of other sedation agents (Goddard et al., 2021; . This level of dosing allows for a rapid onset of dissociation, which is particularly beneficial in emergency scenarios where time is crucial (Zaki et al., 2023; Scheppke et al., 2014).
Dissociative conscious sedation (DCS) has been utilized as an effective alternative to general anesthesia during procedures such as fiberoptic bronchoscopy and laryngeal surgeries (Javid et al., 2015; (Javid & Shaabani, 2015; . This technique often employs subcutaneous administration of ketamine alongside narcotics, achieving satisfactory sedation while minimizing respiratory depression (Javid & Shaabani, 2015; Shabani et al., 2014). This is crucial in scenarios where patient cooperation or airway protection must be maintained, particularly in pediatric procedures (Suryaprakash & Tham, 2017).
Furthermore, the safety profile of ketamine during procedural sedation has been closely examined. Studies indicate that, unlike many other sedatives, ketamine maintains protective airway reflexes and adequate respiratory function, which is critical for ensuring patient safety during sedation (Goddard et al., 2021; Lee & Tham, 2022). Despite its advantageous properties, ketamine administration is not devoid of risks; potential adverse effects such as hypersalivation, laryngospasm, or emergence reactions can occur, necessitating careful monitoring and preparation (Ip & Saincher, 2000).
The empirical data supporting ketamine's use in procedural sedation is robust, driving its adoption in various clinical settings. Research has consistently shown that ketamine can effectively reduce analgesic consumption compared to other methods, thereby improving comfort and outcomes for patients undergoing painful interventions (Javid et al., 2015; (Hopper et al., 2015). Additionally, studies suggest that ketamine's rapid onset and short duration of action enable efficient management of acutely agitated patients, particularly in emergency departments where quick disposition is often necessary (Hopper et al., 2015).
In conclusion, ketamine’s unique dissociative properties and its ability to provide effective sedation and analgesia make it a valuable agent for procedural sedation in medicine. As further research elucidates its mechanisms and optimizes its clinical use, ketamine is expected to continue playing a crucial role in enhancing patient care during various procedures.
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