Recovery agitation ketamine

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... 

Sherwin TS, Green SM, Khan A, Chapman DS, Dannenberg B. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures A randomized, double-bhnd, placebo-controlled trial. Ann Emerg Med 2000 35(3) 229-38. 

Comparative studies Propofol and ketamine have been compared in procedural sedation in the Emergency Department [34. Patients were randomized to propofol 1+0.5 mg/kg every 3 minutes if needed ( =50) or the same doses of ketamine ( =47). There was a higher rate of subclinical respiratory depression with ketamine, but the number of clinical interventions in the two groups was the same. Recovery agitation was more common with the ketamine group than propofol (17% versus 4%), but procedural pain was less common (2.1% versus 6.0%). Recall and patient satisfaction were similar (13% versus 12% and 100% versus 100%). 

The most serious disadvantage to the use of ketamine is its propensity to evoke excitatory and hallucinatory phenomena as the patient emerges from anesthesia. Patients in the recovery period may be agitated, scream and cry, hallucinate, or experience vivid dreams. These episodes may be controlled to some extent by maintaining a quiet reassuring atmosphere in which the patient can awaken or if necessary by administering tran-quilizing doses of diazepam. 

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