262 Intravenous Ketamine: A Safe and Effective Option for Burn Wound Care

Abstract

Very little has been published regarding the safety and efficacy of intravenous (IV) ketamine for burn wound care in adult patients. With increasing attention focused on the adverse effects of opioids, ketamine may serve as a safe sedative and analgesic during wound care and lower the incidence of post-traumatic stress disorder (PTSD) after burn injury. The purpose of this study was to characterize the use of IV ketamine during burn wound care and establish its potential role as a safe and effective adjunct to opioid and benzodiazepine medications. A retrospective review was conducted of adult patients admitted to a regional burn center who received IV ketamine for dressing changes or minor procedures such as skin substitute placement between September 2015 and July 2016. The burn intensive care unit attending administered all IV ketamine doses, and vital signs were monitored every 15 minutes during the procedure. Patient demographics including burn size (percent total body surface area - %TBSA) were recorded. Other data collected included type and duration of procedure and dosages of ketamine, opioid and benzodiazepine. Ketamine-related side effects including hypertension (systolic blood pressure > 200), recall, and dysphoric reactions were also collected. Cardiopulmonary complications such as aspiration, unplanned need for intubation, and myocardial infarction were tracked. A total of 50 patients met inclusion criteria. The mean patient age was 40 ± 15 years with an average burn size of 22 ± 24% TBSA. The mean dose of IV ketamine administered was 1.7 ± 1.2 mg/kg. Length of procedure was noted to be 40 ± 18 minutes. The majority of patients received IV midazolam (98%) at a mean dose of 3.6 ± 2.0 mg. Narcotics were administered to 13 patients (26%) at an average morphine equivalent dose of 14 ± 13 mg. Forty-six (92%) patients denied recall of their wound care. Three patients (6%) experienced a dysphoric reaction. Ketamine-induced hypertension was documented in 3 patients (6%) and all immediately responded to treatment with low-dose labetalol. No cardiopulmonary complications were noted. These findings suggest IV ketamine provides a safe analgesia and sedative option for burn wound care, even for patients with larger burn size in the intensive care unit setting. Patients in this study tolerated ketamine with minimal adverse effects and very few had recall of their wound care. As the growing epidemics of post-burn PTSD and opioid dependence are addressed, IV ketamine for burn wound care warrants further study. Intravenous ketamine is a safe and effective sedative-analgesic agent for utilization in burn wound care.