(106) Assessing the Neuropsychiatric Sequelae of Ketamine After Use for Acute Agitation

Background: Ketamine is primarily known as a commonly used anesthetic agent, but in recent years ‎has increasingly become a mainstay for treatment of acute agitation in emergency departments (EDs) ‎‎(1, 2, 3). Recent studies have focused on its efficacy in treating acute agitation and subsequent ‎complications thereof. However, there remains conflicting information and gaps in knowledge ‎regarding the neuropsychiatric sequelae of ketamine administration for acute agitation (1, 2, 4, 5).‎

Methods: A retrospective chart review of any patient over the age of 18 years old given ketamine for ‎agitation in Lehigh Valley Health Network's ED between 04/26/21 through 10/22/21 was performed. ‎Patients receiving ketamine for procedural or anesthetic use were excluded. The following variables ‎were collected: age, gender, previous psychiatric diagnosis, initial delirium, follow up delirium, ‎emergence reaction, and new psychiatric diagnosis or exacerbation of a prior psychiatric disorder ‎within 30 days of administration. Subsequently, descriptive statistics were conducted.‎

Results: 186 charts were identified, but only 33 met criteria for inclusion. There were 21 males and 12 ‎females. Age of patients ranged from 20-74 years old with a mean age of 43 years. 70% of patients had ‎a previous psychiatric diagnosis, 24% had initial delirium, 0% had follow up delirium, 3% had an ‎emergence reaction, 24% had the onset of a new psychiatric disorder, and 15% had an exacerbation of ‎their psychiatric disorder.‎

Discussion: The results showed minimal risk of neuropsychiatric side effects following ketamine ‎administration for acute agitation. The development of emergence reactions and post-ketamine ‎delirium was rare. Additionally, only a minority of patients had the onset of a new psychiatric disorder.‎

Conclusions/Implications: This study demonstrates the relative lack of neuropsychiatric sequelae ‎following ketamine administration for acute agitation.‎

References: ‎
‎1) Green, Steven M., Mark G. Roback, Robert M. Kennedy, and Baruch Krauss. 2011. "Clinical Practice ‎Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update." Annals of ‎Emergency Medicine 57 (5): 449–61.‎
‎2) Mo, Hanjie, Matthew J. Campbell, Baruch S. Fertel, Simon W. Lam, Elizabeth J. Wells, Elizabeth ‎Casserly, and Stephen W. Meldon. 2020. "Ketamine Safety and Use in the Emergency Department for ‎Pain and Agitation/Delirium: A Health System Experience." The Western Journal of Emergency ‎Medicine 21 (2): 272–81.9‎
‎3) Roppolo, Lynn P., David W. Morris, Fuad Khan, Rohini Downs, Jeffery Metzger, Tiffany Carder, ‎Ambrose H. Wong, and Michael P. Wilson. 2020. "Improving the Management of Acutely Agitated ‎Patients in the Emergency Department through Implementation of Project BETA (Best Practices in the ‎Evaluation and Treatment of Agitation)." Journal of the American College of Emergency Physicians ‎Open 1 (5): 898–907.‎
‎4) Hopper, Austin B., Gary M. Vilke, Edward M. Castillo, Ashleigh Campillo, Timothy Davie, and Michael ‎P. Wilson. 2015. "Ketamine Use for Acute Agitation in the Emergency Department." The Journal of ‎Emergency Medicine 48 (6): 712–19.‎
‎5) Sullivan, Natalie, Chen Chen, Rebecca Siegel, Yan Ma, Ali Pourmand, Nataly Montano, and Andrew ‎Meltzer. 2020. "Ketamine for Emergency Sedation of Agitated Patients: A Systematic Review and ‎Meta-Analysis." The American Journal of Emergency Medicine 38 (3): 655–61.‎