Guidelines for Ketamine administration in Trauma

Recently published research paper evaluates the management of physical pain in trauma care, particularly through the use of ketamine as an analgesic option for emergency trauma patients. The paper discusses the challenges of managing physical pain, emphasizing the potential impact of inadequate pain control on the nervous system and physiological functions, citing studies that indicate how persistent and severe pain can lead to neuroplasticity and the development of chronic pain. Opioids are considered standard for treating severe pain, but their use comes with risks such as addiction, overdose, and increased mortality rates, contributing to the opioid epidemic. Research suggests that over 50% of injured patients receive narcotic prescriptions, leading to prolonged hospital stays and increased ventilator requirements.

Ketamine as an Analgesic Option

Ketamine, a dissociative sedative and NMDA receptor antagonist, is proposed as an alternative analgesic option due to its rapid acceptance and demonstrated efficacy with a wide safety margin. The history of ketamine and its mechanism of action are discussed, emphasizing its potential utility in trauma settings, including joint reductions, sedation, and pain control. The paper details the pharmacological and pharmacokinetic properties of ketamine, including its distribution throughout the body and hepatic clearance, and presents dosing recommendations for different administration routes.

Support for Ketamine Use in Trauma Care

The paper highlights various studies that support the use of ketamine in trauma care by inhibiting opiate tolerance, enhancing opiate analgesia, and offering a safe and effective adjunct to opioid analgesics. It discusses the administration of ketamine through different routes, emphasizing its effectiveness and safety in comparison to opioids. Furthermore, the paper addresses misconceptions about the use of ketamine in patients with increased intracranial pressure, suggesting that evidence supports its safety in traumatic brain injury patients and even indicates neuroprotective properties in adults.

Dosing, Administration, and Future Research

The paper also provides dosing recommendations for achieving analgesic and dissociative effects, and outlines contraindications to ketamine use, along with guidelines for its administration, monitoring, and potential side effects. It emphasizes the multifaceted benefits of ketamine in trauma care, such as providing rapid sedation, facilitating patient management, and serving as an alternative when other pain medications are ineffective or contraindicated. Additionally, it emphasizes the need for continued research and evaluation to further expand the use of ketamine in diverse clinical settings.

Reference –

Reede K, Bartholomew R, Nielsen D, et al. (November 01, 2023) Ketamine in Trauma: A Literature Review and Administration Guidelines. Cureus 15(11): e48099. doi:10.7759/cureus.48099.