ADVERSE EVENTS FROM KETAMINE FOR ADULT PROCEDURAL SEDATION AT THE EMERGENCY DEPARTMENT OF CWM.

Introduction: Procedural sedation involves the use of short-acting analgesic and sedative medications to enable clinicians to perform procedures effectively while monitoring the patient closely for potential adverse effects. Procedural sedation has been practised at the Emergency Department (ED) at Clonial War Memorial Hospital (CWMH) since 2012, however, there has not been an evaluation in terms of the indications, patient demographics and adverse events with ketamine, the most commonly available and used medication for this. In this study, we looked at the incidence rates of adverse events in adult patients receiving ketamine for procedural sedation in the ED, together with the indications, dosages used and demographics of the patients.
Method: Prospective descriptive observational study of patients presenting to CWMH from June 2017 to May 2018 requiring procedural sedation with ketamine. Data collection was prospective with a specifically designed form and consecutive sampling took place. Data were analyzed to calculate rates and ranges and used Microsoft Excel.
Results: Of the 61 patients, 19 (31%)had adverse events which included vomiting (3/61), hypersalivation (1/61) and emergence reactions (17/61). No case of apnoea or laryngospasm was noted. There was a male dominance (74%) for requiring procedural sedation and most procedures were orthopedic related (dislocations and fracture reductions). An average dose of 0.6mg/kg was used with a range of 0.4mg/kg to 1.2mg/kg. Fasting status was observed to not be associated with an increase or decrease in the incidence of vomiting.
Discussion: The incidence rate of adverse events from ketamine for adult procedural sedation in the ED at CWMH was found to be 31%. Safe sedation practices are being employed in the ED during procedural sedation with a senior clinician supervising and complete monitoring of the main parameters taking place for the majority of sedations.