Ketamine (Procedural Sedation / Burns)

How it works

Non-competitive NMDA-receptor antagonism produces dissociation between the thalamocortical and limbic systems, giving profound analgesia and sedation while largely preserving protective airway reflexes.

Prescribing in practice

• Procedural sedation must be delivered by staff competent in airway rescue with full monitoring and resuscitation equipment, as laryngospasm, apnoea, hypersalivation and emergence agitation can occur.
• It increases sympathetic tone, raising heart rate and blood pressure, so use cautiously where this is undesirable such as significant cardiac disease.
• Have suction and antisialogogue measures available because of marked hypersalivation, particularly relevant when working around the airway.

Monitoring

Continuously monitor airway, oxygenation, ventilation and cardiovascular status during sedation and recovery, with a dedicated practitioner responsible for the patient.

Counselling the patient

• Sedation will make the procedure more comfortable and you are unlikely to remember it clearly.
• Arrange for someone to accompany you home and avoid driving, alcohol and important decisions for the rest of the day.

Evidence & guidelines

Ketamine is widely endorsed for procedural sedation in UK emergency and specialty settings, contingent on appropriate monitoring and trained personnel.