I have to admit that the emesis associated with ketamine is definitively one of its down-sides. 7%
is acutally quite a bit.   The one thing I have found is that warning the parents up front, and I
usually say that their child will quite likely vomit, helps.  I had only one case that was
persistant, after a bit of an overdosage (8mg/kg IM), that resolved with tigan.

The big problem I see with pre-medicating for ketamine is the issue of administration.  The huge
selling feature of ketamine to my mind is its consitant efficacy when given IM.  If one truly
wants to pre-med with an anti-emetic than it needs to be given some time before the ketamine -
thus either an additional injection or an IV - both of which are somewhat unattractive

I do routinely pre-medicate patients that I use etomidate for b/c the rather high incidence of
emesis.  (0.1mg/kg reglan) with good results.  Propofol is quite nice in this regard b/c of its
anti-emetic properties.

Virgil Davis, MD

Univ of Arizona.

Steve Green wrote:

> 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.
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