The College Guidance on Ketamine came out earlier this year. It includes the following...

 

5. At least three staff are required: a doctor to manage the sedation and airway, a clinician

to perform the procedure and an experienced nurse to monitor and support the patient,

family and clinical staff.

 

Since the early 90’s we have been using low dose i.m. ketamine at Lancaster with a doctor and nurse with no critical incidents.

 

I asked the advice of Steve Green the USA Ketamine expert and his response was...

 

“In the USA the ASA and AAP guidelines both dictate 2 doctors for deep sedation, but yet moderate sedation can have just 1 doctor and a monitoring nurse. They don't mention ketamine specifically and where it should best fall, and as you no doubt know the dissociative state doesn't formally meet the definitions of either deep or moderate sedation. That being said, at Loma Linda from the 1980s on we have never required 2 doctors and quite commonly the only doctor is the one doing the procedure (although always a procedure that could be quickly interrupted). Requiring 2 doctors is prohibitive in many EDs where only a single doctor is available.”

 

Of course the College of Anaesthetists were insisting on two doctors for a Bier’s Block for years........ which was not normal practice in Emergency Medicine.

 

What is your practice for ketamine?

 

Ray McGlone

Lancaster.... where it is still raining!