Comprehensive Summary
Türkücü et al. conducted a 9-month randomized clinical trial to compare the incidence of recovery agitation between two different doses of intravenous ketamine hydrochloride during procedural sedation in the emergency department. Recovery agitation was defined as a Richmond Agitation-Sedation Scale score of +2 to +4 during recovery. The trial enrolled 108 patients aged 18-75 years, randomized equally to receive intravenous ketamine at either 1 mg/kg or 0.5 mg/kg. Sedation depth and agitation were assessed using RASS at 5, 15, and 30 minutes post-procedure, with vital signs monitored throughout recovery.Secondary outcomes included sedation duration and need for additional dosing. Recovery agitation occurred in 20.4% of the low-dose group and 22.2% of the high-dose group, a nonsignificant difference, and vital signs and sedation duration were comparable between groups. The authors concluded that both ketamine doses were safe and effective, with no meaningful difference in recovery agitation or other outcomes. Limitations included the modest sample size, single-center design, and variability in how recovery agitation is defined across studies.
Outcomes and Implications
Although no significant differences were observed, this study provides evidence to guide ketamine dosing decisions in ED procedural sedation .The findings suggest that a lower dose (0.5 mg/kg) may be favored, as it minimizes drug exposure and the risk of overdose without compromising safety or effectiveness in a quick recovery. These results may inform updates to sedation protocols, encourage evidence-based dosing practices, and reinforce the importance of tailoring sedation to individual patient needs rather than assuming higher doses are superior.