Ketamine for Acute Agitation

Purpose of ReviewThis review describes the use of ketamine for acutely agitated patients in the emergency care setting. Evidence for its efficacy will be reviewed and practical suggestions for using ketamine in this scenario will be presented.Recent FindingsThe available observational literature on the topic of ketamine for agitation was recently summarized in a systematic review. This review found that ketamine effectively and quickly sedates acutely agitated patients. However, it did raise some concerns about an increased intubation rate in patients administered ketamine.SummaryIn severely agitated patients, particularly those presumed to be caused by stimulant drug use, who need immediate sedation to ensure the safety of the patient and staff, ketamine is a reasonable and safe choice. Emergency practitioners can consider giving ketamine 4-6 mg/kg IM (500 mg for most adults). Once given, it is important to closely monitor the patient for adverse effects and that the examination continue to determine the etiology of the patient's agitation.