Ketamine emergence delirium

Ketamine <1 Dissociative Yes No Slight Minimal emergence delirium IM or IV... 

Emergence delirium with restlessness, disorientation and unpleasant dreams or hallucinations may occur for up 24 hours following ketamine administration. Their incidence is reduced by psychological preparation of the patient, avoidance of verbal and tactile stimulation during the recovery period, or by concomitant administration of opioids, benzodiazepines, propofol or physostigmine. However, unpleasant dreams may persist. 

The duration of the drug s action depends on the method of administration. Upon recovery from ketamine, the patient or user may be agitated, disoriented, restless, and tearful. This is called emergence delirium. Patients may continue to experience unpleasant dreams up to 24 hours after the drug has been taken. Flashbacks have been reported, and their incidence may be higher than with many hallucinogens.55... 

Ketamine often causes emergence delirium and disturbing dreaming. Benzodiazepines are often co-adminis-tered to attempt to manage this. The optimal dose of diazepam to add to ketamine-fentanyl field anaesthesia has been assessed in a randomized double-blind study in 400 patients from Vanuatu the optimal dose was 0.1 mg/ kg (436). 

Ketamine, a compound chemically related to PCP, is used primarily as a veterinary anesthetic but has gained popularity recently as a recreational drug Once used extensively in human medicine, it has fallen out of favor because of emergence delirium, characterized by hallucinations, delirium, vivid dreams, and other psychiatric effects. This untoward effect as a medicinal agent is precisely the effect that recreational users are seeking. 

Emergence from ketamine s anesthesia may be associated with psychological manifestations such as pleasant dream-like states, vivid imagery, hallucinations and emergence delirium, sometimes accompanied by confusion, excitement, and irrational behavior. The duration is ordinarily a few hours however, recurrences have been seen up to 24 hours postoperatively. No residual psychological... 

Unlike other parenteral anesthetics, ketamine increases cerebral blood flow and ICP with minimal alteration of cerebral metabolism. These effects can be attenuated by concurrent administration of thiopental and/or benzodiazepines along with hyperventilation. However, given that other anesthetics actually reduce ICP and cerebral metabohsm, ketamine is relatively contraindicated for patients with increased ICP or those at risk for cerebral ischemia. The effects of ketamine on seizure activity are mixed. Emergence dehrium characterized by hallucinations is a frequent comphcation of ketamine that can result in serious patient dissatisfaction and can complicate postoperative management. Delirium is most frequent in the first hour after emergence and appear to occur less frequently in children benzodiazepines reduce the incidence of emergence delirium. 

Psychological The incidences of different types of emergence phenomena after intravenous ketamine, mean dose 1.15 mg/kg, for procedural sedation have been investigated in children [40 ]. Of 745 patients, 93 (13%) cried on awakening from sedation, of whom 84 were consoled by their parents. The rest were defined as having emergence delirium. Another seven children were... 

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