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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
>addressing this.


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
promethazine (3).

Steve Green

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;
35:35-42.
3. Li J: Ketamine: emergency applications. In: Plantz SH, senior editor.
Emergency Medicine Text. Boston: Boston Medical Publishing Corp., 1999.
www.emedicine.com/emerg/topic802.htpm

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