Desaturation ketamine

Ketamine-I-morphine has been compared with morphine in intravenous patient-controlled analgesia [132 ]. In seven studies there were higher frequencies of adverse reactions (including nausea, pruritus, sleepiness, desaturation, and urinary retention) when morphine was used alone four studies did not report any difference. 

Michelet P, Guervilly C, Helaine A, et al. Adding ketamine to morphine for patient-controlled analgesia after thoracic surgery influence on morphine consumption, respiratory function, and nocturnal desaturation. Br JAnaesth 2007 99 396-403. 

In a randomized blind comparison, patients undergoing sedation for emergency procedures received either ketamine 0.3 mg/kg or fentanyl 1.5 micrograms/kg followed by intravenous propofol 0.4 mg/ kg bolus [62 ]. All five severe events were in those who received fentanyl and fentanyl caused more mild (OR = 5.9), moderate (OR = 3.8), and severe (OR = 12.3) adverse events. Desaturation was the main contributor to this difference. Fentanyl was 5.1 times more likely to cause sedation than ketamine, and this persisted after adjustment for age, weight, procedure type, and pre-procedure pain (OR = 4.6). 

Propofol In a randomized study in 60 children who underwent interventional radiology and were allocated to propofol 0.5 mg/kg - -fentanyl 1 microgram/kg + ketamine 0.5 mg/kg ( = 30) or propofol 0.5 mg/kg - - fentanyl 1 microgram/kg + saline 0.9% ( = 30) intravenously, there was oxygen desaturation in three of those who received ketamine and nine of those who did not [80 ]. Those who received ketamine also had agitation n = 2) and tachycardia ( = 1), which did not occur in the other group. Nystagmus was also a common adverse reaction (19 cases versus... 

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