Four good reasons to choose ketamine in the emergency department. A case series and literature review

Abstract

Ketamine is a fast-acting N-methyl-D-aspartate (NMDA) receptor antagonist that can be used in a range of clinical scenarios in the pre-hospital setting and emergency department (ED). When compared with other anesthetic agents, ketamine has many unique properties, such as the ability to produce dose-dependent analgesic and anesthetic effects with a wide margin of safety. Ketamine may be used in the ED for sedation, pain management, and acute agitation treatment in the cases of benzodiazepine (BDZ)-resistant alcohol withdrawal syndrome (AWS) and substance use disorder. To highlight the efficacy and safety of ketamine, we reviewed the literature, starting with a description of four different cases of patients who presented to our ED and were treated with ketamine.