Ketamine (Burns Procedural Analgesia)

How it works

It produces dissociative analgesia and anaesthesia mainly by non-competitive antagonism of the NMDA glutamate receptor, with relative preservation of airway reflexes and respiratory drive at analgesic levels.

Prescribing in practice

• Use only with appropriate monitoring and staff trained in airway management and resuscitation, as emergence phenomena, hypersalivation and, with rapid or high dosing, respiratory and cardiovascular effects can occur.
• It raises blood pressure and heart rate and should be used cautiously in uncontrolled hypertension or significant cardiac disease.
• Co-administered benzodiazepines can attenuate distressing emergence reactions but add to sedation, requiring vigilant observation.

Monitoring

Monitor conscious level, airway, oxygen saturation, and cardiovascular parameters throughout the procedure and into recovery.

Counselling the patient

• You may feel detached, dreamlike or experience vivid imagery during the procedure, which wears off as the drug leaves your system.
• Do not drive or make important decisions for the remainder of the day after sedation.

Evidence & guidelines

Ketamine is a long-established agent for procedural analgesia and sedation, valued in burns care for analgesia with relative cardiorespiratory stability.