![Room9er ["Room Niner"]:](https://room9er.com/wp-content/uploads/2020/03/cropped-Screen-Shot-2020-03-08-at-3.16.16-PM.png)
I witnessed the third patient to have apnea as a side effect of ketamine administration. As in the other two cases ketamine was infused as a push, rather than the slow administration. This was not the resident, but typically and to be by the book, MDs should be the ones pushing ketamine. SLOWLY.
In this case our resident did well managing the sedation. Hypoventilation was diagnosed well before desaturation. Painful stimuli did not induce respirations as the ketamine is too good of an analgesic. We began to BVM ventilate, placed nasal trumpet, sat was never lower than 85%. Took about 8 minutes to get spontaneous respirations. We gave narcan as the patient had fentanyl prior to ketamine. As in one other case of ketamine apnea the narcan did not help, but should be attempted.
So learning point. NEVER SLAM ketamine into the patient. Dilute the 1cc (50mg-100mg) of ketamine in 10cc of saline if it will help the temptation to push it.
Also follow the algorithm below for PSA intervention. We will have the sedation review sheet and reference card finished soon.
Dr. Mallory just watched me push in Ketamine, and although I didn’t really slam it, I didn’t really give it over the recommended time period (The IV dose should be administered over a period of 60 seconds.) But my patient did look at me and say “Really Dude?, Did you havejdsjakl;dsa” and then he was out……but nonetheless if we’re pushing it (which is the case at UofL) we should know how to do it.
Were you doing a ketamine only sedation? And what was the indication? And what was the age of the patient and/or risk factors?
late 30s female. no known psych hx but she was kind of hysterical so pretreated with versed 2mg. meds were fentanyl, then 25 ketamine for pain control. then 10 min later versed 2mg and keatmine 50mg. she did not completely dissociate after 50 so i ordered 50 more. this dose was given very quickly and she had the apnea about 2-3 minutes after the dose. she was asa 1, no real risk factors. denied substance abuse. indication was for inferior shoulder dislocation after motorcycle. no head injury. completely stable otherwise.
lesson learned… we should be pushing the ketamine or at least instructing the nurses how to do so. also ketamine doesn’t have an immediate effect. probably should have waited a little bit longer to give the other 50mg of Ketamine to make sure the first dose had time to make its effect. no harm done here in the long run. patient had no recollection of the events when she was discharged. this was my first bad case with ketamine ever… hopefully won’t be happening again!