台灣急診醫師使用Ketamine之現況探討

Translated title of the contribution: Use of Ketamine by Emergency Physicians and in Pediatric Procedure in Taiwan

Hon-Ping Ma, Zong-Lun Wang, Hang Chang, Wai-Shing Leung, Chien-chih Chen, Chee-Fah Chong

Research output: Contribution to journalArticle

Abstract

The objectie of this study was to investigate the current practice of ketamine sedation in emergency departments (EDs)in Taiwan and to determine the safety of intramuscular ketamine when administered by emergency phyxicians (EPs) for pediatric procedures in accordance with a defined protocol.
Questionnaires were collected form 195 board-certified emergency physicians in Taiwan concerning their experience in using ketamine. Indications, frequency, adverse reactions, and obstacles in choosing this drug as a sedative in the ED were reviewed. We also retrospectively reviewed 76 consecutive pediatric trauma patients who visited oru emergency department (from January 1,1998 to December 31,2000)who received ketamine anesthesia for painful or frightening procedures. Their safety profiles and length of stay in the emergency department were also studied.
Eighty-six emergency physicians who completed their questionnaires were enrolled in our survey .Only 48 EPs (55.8%) had clinical experience with ketamine sedation in the ED and 79.2% of them predicted that ketamine was used less than 10 times a month in their EDs . Most EPs (98.8%) used ketamine for simple pediatric procedures such as laceration repair and nail removal. EPs usually hesitated to choose this agent in the ED due to the fear that it might prolong the length of stay of patients (64.6%)and cause adverse reactions (27.1%). Nearly half (45.8%)of those who had used ketamine reported that emesis was the most commonly encountered adverse reaction. As many as 38 EPs(44.2%) had no experience in ketamine sedation. Factors that hindered ketamine’s use in ED patient care include: (a) ketamine was not readily available in the ED (84.2%) and (b) the treating physicians was not familiar with its pharmacokinetics and pharmacodynamics (63.2%) and patient monitoring during and after sedation (60.5%).The medical charts of 76 consecutive admitted for trauma treated with intramuscular ketamine in our hospital were reviewed . Airway complications were not found .Mild adverse reactions occurred in 5.3% and included: emesis without evidence of aspiration (n=4),and excessive salivation (n=1) . No child required hospitalization for complications caused by ketamine. The average time form injection to ED discharge was 90 minutes for children given a single intramuscular ketamine injection.
Intramuscular ketamine may be administered safely by emergency physicians for pediatric procedures with a well-defined protocol and with appropriate monitorin.But its use by emergency physicians in the emergency department is still a rarity in Taiwan due to physician inexperience and drug unavailability. Although no serious complications were noted in our series, larger prospedtive studies are needed to establish ketamine’s safety profile in Taiwan’s EDs. We anticipate that the use of ketamine by emergency physicians will become standardized in the near future.
Translated title of the contributionUse of Ketamine by Emergency Physicians and in Pediatric Procedure in Taiwan
Original languageTraditional Chinese
Pages (from-to)11-17
Number of pages7
Journal中華民國急救加護醫學會雜誌
Volume13
Issue number1
Publication statusPublished - 2002
Externally publishedYes

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