Injury. 1997 Jan;28(1):41-3.
Ketamine in the field: the use of ketamine for induction of anaesthesia
before intubation in injured patients in the field.
Gofrit ON, Leibovici D, Shemer J, Henig A, Shapira SC.
Israel Defense Forces, Medical Corps, Tel Aviv University, Israel.
Intubating the subconscious, struggling patient in a pre-hospital setting
can be a difficult task even in experienced hands. We performed a clinical
prospective study to evaluate the applicability of ketamine for induction
of anaesthesia before intubation in the field. Ketamine was distributed to
all air medical rescue teams--trained reserve army volunteers from various
medical specialties. Lectures and literature concerning the use of
ketamine for anaesthesia induction before intubation were given. The
physicians were instructed to administer ketamine, in a dose of 2 mg/kg
intravenously, if a single intubation attempt failed. Following the
administration of ketamine, a questionnaire was filled in by the
physician. Analysis of the data was performed after 24 months. During the
study period, intubation was indicated in 161 injured patients evacuated
by air in Israel. In 29 patients (18 per cent) the first intubation
attempt had failed and they were given ketamine. The reasons for failure
of the first intubation attempt were restlessness or trismus in 23
patients and traumatic distortion of the upper airway anatomical landmarks
in six. Following ketamine administration, intubation was successful in 19
patients (65.5 per cent) in all of whom the indication for ketamine
administration was restlessness or trismus. All patients with upper airway
anatomy distortion were given a cricothyroidotomy. There were no
complications attributed to ketamine. All patients reached hospital alive.
This preliminary study suggests that the use of ketamine in this
pre-hospital setting is safe. The drug is effective in cases where the
primary reason for failure to intubate is restlessness or trismus. The
drug is not effective in cases of anatomical damage to the upper airway.
In these cases, cricothyroidotomy should probably be performed as early as
Michael Bjarkoy said:
> Apologies Marten,
> The way I read the last line of your post seemed to me that you only
> Paramedic evidence - silly me.
> I will get back to you on the Dutch data if they have anything - probably
> would be better for you to post direct to him - I will cross post your
> original email to him and a few other people if that's OK.
> ----- Original Message -----
> From: "Howes, Marten" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Thursday, March 10, 2005 12:18 PM
> Subject: data/studies on using ketamine prehospital
>> any available? - all I could find was these 2 articles.
>> Porter K. Ketamine in preshospital care.Emerg Med J 2004;21:351-354.
>> Roberts K, Bleetman A. An email audit of prehospital doctor activity in
>> area of the West Midlands. Emerg Med J 2002;19:341-344
>> I know many of us use ketamine during the initial phase of treating
>> patients, either as the induction agent for RSI or for dissociation
>> patient transfers, reduction of fractures, painful procedures. Ketamine
>> also used by many prehospital immediate care doctors....but very little
>> published evidence in this setting (Roberts' article being the only one,
>> smallish case series). I am after any data that list subscribers may
>> or at least some references! Happy to enter into correspondence off
>> Also, do any ambulance services use ketamine? (by paramedics, not
>> anywhere in the world..........aside from Western Australia that is.....
>> Dr Marten C Howes MRCP(UK) FFAEM FACEM
>> Staff Specialist
>> Emergency Department
>> Bunbury Regional Hospital
>> BUNBURY WA 6230
>> Tel: +8 9722 1000
>> Fax: +8 9722 1019
>> [log in to unmask]
>> [log in to unmask]
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