Prehospital Use of Ketamine: A Systematic Review | Biomedgrid

Acute pain and agitation are common presentations that must be addressed in the prehospital setting by paramedics. Opioids are most frequently used to control acute pain but are highly addictive and patients can develop dependence even from short term use. For sedation, many different medications such as benzodiazepines and haloperidol are used, but their delayed onset of action is not desirable and side effects at effective doses (e.g. CNS depression) can be potentially harmful to the patients. In recent years, ketamine has been used as a safer alternative for prehospital analgesia and sedation in the military setting, but has not been studied sufficiently in the civilian setting to be a part of standard protocol nationwide [1] . Ketamine's primary action is to block glutamate from acting on the n-Methyl-d-Aspartate (NMDA) receptor resulting in a “dissociative anesthesia” state. It also works on other cellular processes such as hyperpolarization-activated cyclic nucleotide channels (HCN1), cholinergic, aminergic, and opioid systems making it useful for both analgesia and sedation [2].