Ketamine drip anyone?

[polygonal]

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Does anyone use a ketamine drip for sedation on intubated pts?

I had a guy last night with bad pneumonia, CHF and COPD/asthma in respiratory failure. Did well on NIV then tanked. Tubed him (used ketamine and sux per junior resident request). Started on propofol drip (pressure good still). He then become very hypotensive and was bucking the vent and became hypoxic. I paralyzed him and he did well.

I've never used ketamine for anything other than induction and procedural sedation. I know it can be used for longer term sedation. I often find myself in a crunch with hypotensive pts on the vent and I'm wondering why we don't use ketamine drips? Hemodynamically stable. Bronchodilator. No adrenal suppression (I know). I don't care about emergence at that point.

Thoughts?

 

[Stitch]

I'm seeing a very different population than you (no COPD and limited CHF), but the only time we use ketamine drips at my institution is with the asthmatics. It works quite well. I can't speak for how others do it, or if they do, however.

 

[Hamhock]

Does anyone use a ketamine drip for sedation on intubated pts?

I had a guy last night with bad pneumonia, CHF and COPD/asthma in respiratory failure. Did well on NIV then tanked. Tubed him (used ketamine and sux per junior resident request). Started on propofol drip (pressure good still). He then become very hypotensive and was bucking the vent and became hypoxic. I paralyzed him and he did well.

I've never used ketamine for anything other than induction and procedural sedation. I know it can be used for longer term sedation. I often find myself in a crunch with hypotensive pts on the vent and I'm wondering why we don't use ketamine drips? Hemodynamically stable. Bronchodilator. No adrenal suppression (I know). I don't care about emergence at that point.

Thoughts?

I know absolutely nothing about ketamine drips; and so I am wondering/would be concerned about keeping sufficient sedation...borderline sedation --> I wonder about recurrent emergence...titration would have to be to extra deep, no?

HH

...and, of course, in the perfect population

 

[kungfufishing]

ketamine is one of the most commonly used anesthetics in the world and for good reason. I haven't used it as a sedation gtt but there are scenarios in which it might be a great idea. Could perhaps even use it as a second drug for folks on diprivan, sort of a ketafol drip.

 

[EctopicFetus]

ketamine is one of the most commonly used anesthetics in the world and for good reason. I haven't used it as a sedation gtt but there are scenarios in which it might be a great idea. Could perhaps even use it as a second drug for folks on diprivan, sort of a ketafol drip.

The EMRap in March or April talked about this in trauma patients with good outcomes. I havent done this but seems to make sense. When patient have unstable vitals use Versed and fentanyl drips.

 

[NateintheED]

The EMRap in March or April talked about this in trauma patients with good outcomes. I havent done this but seems to make sense. When patient have unstable vitals use Versed and fentanyl drips.

I've used it on one patient with very good effect. Pt had horrible CHF and diastolic dysfunction & flash pulmonary edema with BP all over the place - up/down/up/down the minute you even brought a vasoactive med into the room! Remember that versed does have some hypotensive effect, though not as much as propofol. Not sure why we don't use ketamine drips more, probably more a matter of institutional/personal preference than any real medical reason.