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. 2021 Mar 31;13(3):e14228.
doi: 10.7759/cureus.14228.

Effect of Ketamine on Cardiovascular Function During Procedural Sedation of Adults

Kara Goddard  1 , Christopher Sampson  1 , Starr-Mar'ee Bedy  1 , Rugheed Ghadban  2 , Julie Stilley  1
Affiliations

Effect of Ketamine on Cardiovascular Function During Procedural Sedation of Adults

Kara Goddard et al. Cureus. .

Abstract

Introduction: Ketamine is commonly used in emergency department procedural sedation. Mild to moderate transient increases in blood pressure, heart rate, and cardiac output are common due to ketamine causing an increase in sympathetic activity. There is a concern that these physiological changes could result in an increased myocardial oxygen demand that may exacerbate underlying cardiac disease.

Methods: Convenience sample of patients older than 50 years receiving ketamine for procedural sedation in the emergency department was used (n = 31). Patients were selected to receive ketamine based on provider discretion. Primary outcome was incidence of new myocardial ischemia apparent on an electrocardiogram (ECG). ECGs were obtained prior to sedation and during the sedation approximately one minute after administration of ketamine. ECGs were reviewed by a board-certified emergency medicine physician and a board-certified cardiologist.

Results: New onset ischemia was found in 9.7% (3/31) of ECGs. Of these, one was in a patient who had previously received ketamine without evidence of ischemia on the repeat ECG. There were no statistically significant differences between the groups. Evidence of ischemia on ECG did not impact patient disposition.

Conclusions: Ketamine is a useful medication in procedural sedation; however, careful attention should be made in patient selection when ketamine is the desired agent. Consideration might be made in using the lowest possible dose of ketamine to obtain adequate sedation in order to hopefully lessen the occurrence of ECG changes suggestive of myocardial ischemia. Based on this small sample, single-site study, no evidence of statistically or clinically significant ischemia was seen with the use of ketamine for procedural sedation. Ketamine remains a safe medication option in adults undergoing procedural sedation.

Keywords: ischemia; ketamine; sedation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Medications Administered With Ketamine
Figure 2
Figure 2. Variability of Vital Signs During Sedation
HR, Heart rate; SBP, systolic blood pressure; DBP, diastolic blood pressure.
Figure 3
Figure 3. Baseline ECG on Second Visit
ECG, Electrocardiogram.
Figure 4
Figure 4. Post-ketamine ECG With Ischemia Present in Leads V4 and V5
ECG, Electrocardiogram.
See this image and copyright information in PMC

References

    1. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Green SM, Roback MG, Kennedy RM, Krauss B. Ann Emerg Med. 2011;57:449–461. - PubMed
    1. Drugs that may cause or exacerbate heart failure: a scientific statement from the American Heart Association. Page RL 2nd, O'Bryant CL, Cheng D, et al. Circulation. 2016;134:0–69. - PubMed
    1. Hemodynamic and metabolic effects of ketamine anesthesia in the geriatric patient. Stefánsson T, Wickström I, Haljamäe H. Acta Anaesthesiol Scand. 1982;26:371–377. - PubMed
    1. Survival of female geriatric patients after hip fracture surgery. A comparison of 5 anesthetic methods. Wickström I, Holmberg I, Stefánsson T. Acta Anaesthesiol Scand. 1982;26:607–614. - PubMed
    1. Ketamine reduce left ventricular systolic and diastolic function in patients with ischaemic heart disease. Jakobsen CJ, Torp P, Vester AE, Folkersen L, Thougaard A, Sloth E. Acta Anaesthesiol Scand. 2010;54:1137–1144. - PubMed

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