This was really a study of "we did it and we liked it."
This was not a prospective trial but rather a chart review. Even the best of chart reviews will suffer from the quality of the data recorded. Do we really believe that there was only a 6% adverse event rate when prospective studies have shown it to be as high as 80%?
Sure, ketamine at these low doses is probably very safe. But who cares! We have another class of medications that we know work in the vast majority of patients when dosed appropriately. These are called opiates. Ever heard of them? We have decades of experience with them. They are completely reversible and rarely a problem in the vast majority of patients. Why are we trying to fix something that is not broken! Of course there may be times when an adjunct is necessary (i.e. IV drug abuser) but this should be a rare event.
The amount of times that I have seen patients wacked out on ketamine has convinced me stick with opiates the vast majority of the time.
A non-randomized retrospective chart review or "Mikey liked it" paper shouldn't change anybody's mind.
You are correct that this paper can be seen as a "we did it and we liked it".
But I disagree with your premise that opiates are equally effective and safe when used appropriately. Specifically the hypotensive trauma patient in pain or the tentative airway patient. These are two of numerous examples of patients who are better managed with ketamine.
While this paper alone should not convince anyone to change their practice, it is only one of a number of papers showing the safety, efficacy and superiority of ketamine over opioids in a number of clinical scenarios.
John Hipskind, MD, FACEP
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Brian D. - July 26, 2015 2:40 AM
This was really a study of "we did it and we liked it."
This was not a prospective trial but rather a chart review. Even the best of chart reviews will suffer from the quality of the data recorded. Do we really believe that there was only a 6% adverse event rate when prospective studies have shown it to be as high as 80%?
Sure, ketamine at these low doses is probably very safe. But who cares! We have another class of medications that we know work in the vast majority of patients when dosed appropriately. These are called opiates. Ever heard of them? We have decades of experience with them. They are completely reversible and rarely a problem in the vast majority of patients. Why are we trying to fix something that is not broken! Of course there may be times when an adjunct is necessary (i.e. IV drug abuser) but this should be a rare event.
The amount of times that I have seen patients wacked out on ketamine has convinced me stick with opiates the vast majority of the time.
A non-randomized retrospective chart review or "Mikey liked it" paper shouldn't change anybody's mind.
Brian Doyle, MD FACEP FACEM
John H., M.D. - September 5, 2015 2:49 PM
Brian:
You are correct that this paper can be seen as a "we did it and we liked it".
But I disagree with your premise that opiates are equally effective and safe when used appropriately. Specifically the hypotensive trauma patient in pain or the tentative airway patient. These are two of numerous examples of patients who are better managed with ketamine.
While this paper alone should not convince anyone to change their practice, it is only one of a number of papers showing the safety, efficacy and superiority of ketamine over opioids in a number of clinical scenarios.
John Hipskind, MD, FACEP