At 03:31 AM 3/31/00 -0500, Gabors wrote:
>Has anybody looked at the use of anti-emetics with ketamine? The only
>downside of its use in my practice has been that a few patients vomit after
>the dissociation wears off. I have not routinely given an anti-emetic on a
>prophylactic basis - and a quick search did not find anything specifically
This has not been studied, and since the overall prevalence of emesis is
only 6.7% (1) the role for routine prophylactic therapy is unclear. Older
children are at higher risk, although the prevalence in 10-15 yo's is still
only 17% (2).
A randomized controlled trial designed to detect a 50% reduction in emesis
(ie, from 6.7% to 3.3%) would require 1,404 total subjects (Stata 6.0,
alpha=.05, beta=0.2). Any takers? ;)
Individuals interested in the concept of prophylactic antiemetics should
definitely read James Li's anecdotal experience in Africa using
1. Green SM, Rothrock SG, Lynch EL, et al: Intramuscular ketamine for
pediatric sedation in the emergency department: Safety profile with 1,022
cases. Ann Emerg Med 1998; 31:688-697.
2. Green SM, Kuppermann N, Rothrock SG, Hummel CB, Ho M: Predictors of
adverse events with ketamine sedation in children. Ann Emerg Med 2000;
3. Li J: Ketamine: emergency applications. In: Plantz SH, senior editor.
Emergency Medicine Text. Boston: Boston Medical Publishing Corp., 1999.
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