Asian Journal of Medical Principles and Clinical Practice

Use of Ketamine for Sedation and Analgesia in the Emergency Department Compared to Alternatives: A Systematic Review and Meta Analysis

Majed Alawe Alotaibi

Emergency Department, General Hospital, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.

Auday A. Alkhunaizi

Emergency Department, General Hospital, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.

Khalid Abdulaziz Alsunidy

Emergency Department, Imam Abdulrahman Alfaisal Hospital, Riyadh, Kingdom of Saudi Arabia.

Shatha Yahya Alothaimeen

Emergency Department, General Hospital, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.

Saud Hassan Shuraym

Emergency Department, General Hospital, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia.

*Author to whom correspondence should be addressed.

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Abstract

To carry out painful treatments in the ED successfully, procedural sedation is required. The two most widely utilised drugs are ketamine and benzodiazepines/opioids, with ketamine offering sufficient analgesia and maintaining airway muscle tone. While benzodiazepines and opioids can cause respiratory depression, ketamine is linked to negative side effects. The effectiveness and safety of ketamine and midazolam/fentanyl are contrasted in this study. A database search and a manual search that involved looking through the reference lists of papers that the database search had turned up were both utilized to find research that were pertinent to our issue. Using the Cochrane risk of bias tool in the Review Manager software (Review Manager (RevMan) (Computer programme), a methodological quality analysis of the articles that were eligible for inclusion was done. The Cochrane Collaboration, Version 5.4, 2020).

Additionally, pooled analysis was carried out with the aid of the Review manager programme. Seven of the 1366 papers in the study were chosen for examination. Combined data revealed that the effects of ketamine and midazolam/fentanyl on pain scores during procedures and the depth of sedation assessed by the University of Michigan sedation scale were comparable. The ketamine group, however, had much more deep sedation as measured by the Modified Ramsay Sedation Score. Vomiting and nausea were the only notable side effects, and they were more common in the ketamine group. Our data indicate that ketamine is just as effective for procedural sedation as the combination of midazolam and fentanyl, but it is linked to more side effects. Consequently, midazolam/fentanyl can be suggested for procedural sedation in the emergency department.

Keywords: Systematic review and meta-analysis, emergency department, PSA, procedural sedation and analgesia, ketamine, opioids, benzodiazepines

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