I have been using Ketamine in two hospitals that I have worked in using 4mg/kg.
I'm a great fan and, perhaps more objectively, I find the nurses steering children
towards me. I use the Loa Linda protocol developed by Steve Green. (Numerous
ketamine publications!) The main problems that I find with it are more practical
than clinical. It ties up a nurse for about an hour, which is just not practical
when we're busy. Finding a quiet room can also be tricky, I usually end up using
a gynae cubicle. At this dose, it is really an anaesthetic, rather than a sedative,
since verbal contact is lost. This upsets a lot of anaesthetists, though I'm
not really sure why. Their argument that it is unsafe doesn't hold up. I'm sure
some guidance from BAEM would be helpful, since this is an issue that causes
a lot of discussion between departments.
Adrian Boyle
SPR East Anglia
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