Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 21;14(6):e26162.
doi: 10.7759/cureus.26162. eCollection 2022 Jun.

A Comparative Analysis Between Ketamine Versus Combination of Midazolam and Haloperidol for Rapid Safe Control of Agitated Patients in Emergency Department: A Systematic Review

Hany A Zaki  1 , Eman Shaban  2 , Khalid Bashir  3   1 , Haris Iftikhar  1 , Adel Zahran  1 , Emad El-Din M Salem  4 , Amr Elmoheen  1
Affiliations
Review

A Comparative Analysis Between Ketamine Versus Combination of Midazolam and Haloperidol for Rapid Safe Control of Agitated Patients in Emergency Department: A Systematic Review

Hany A Zaki et al. Cureus. .

Abstract

We aim to discuss the efficacy and adverse effects of using ketamine in agitated patients in the emergency department (ED) compared with the combination therapy of haloperidol with benzodiazepine. This systematic review followed Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. An electronic search from PubMed/Medline, Cochrane library, and Google Scholar was conducted from their inception to 30th April 2022. We included agitated patients in ED who were given infusion with ketamine only. Our comparative group was patients infused with combined therapy of haloperidol and benzodiazepine. We did not include letters, case reports, abstracts, conference papers, appraisals, reviews, and studies where full text was unavailable. We did not put any language restrictions. Three studies were selected in our manuscript (one cohort and two randomized controlled trials). All three studies showed that ketamine was used to achieve sedation in less time than the other group. However, two studies reported significantly more adverse effects in ketamine-infused groups. We concluded that ketamine use is superior when its primary focus is to sedate the patient as quickly as possible, but it carries some side effects that should be considered. However, we still need more studies assessing the efficacy of ketamine in agitated patients presenting in the ED.

Keywords: agitated patients; benzodiazepine; efficacy; haloperidol; ketamine.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram of the literature search results
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
See this image and copyright information in PMC

References

    1. Medical conditions and restraint in patients experiencing excited delirium. Strote J, Walsh M, Auerbach D, Burns T, Maher P. http://10.1016/j.ajem.2014.05.023. Am J Emerg Med. 2014;32:1093–1096. - PubMed
    1. An awkward position: restraints and sudden death. Abdon-Beckman D. https://pubmed.ncbi.nlm.nih.gov/10172941/ JEMS. 1997;22:88–94. - PubMed
    1. Verbal de-escalation of the agitated patient: consensus statement of the american association for emergency psychiatry project BETA de-escalation workgroup. Richmond JS, Berlin JS, Fishkind AB, et al. West J Emerg Med. 2012;13:17–25. - PMC - PubMed
    1. Benzodiazepine pharmacology and central nervous system-mediated effects. Griffin CE 3rd, Kaye AM, Bueno FR, Kaye AD. https://www.ochsnerjournal.org/content/13/2/214. Ochsner J. 2013;13:214–223. - PMC - PubMed
    1. Pharmacokinetics and pharmacodynamics of sedatives and analgesics in the treatment of agitated critically ill patients. Wagner BK, O'Hara DA. Clin Pharmacokinet. 1997;33:426–453. - PubMed

LinkOut - more resources