Inhaled Nitrous Oxide for the Prevention of Emergence Reaction During Ketamine Administration in Adults, a Pilot Study
Status:
Completed
Trial end date:
2016-04-01
Target enrollment:
Participant gender:
Summary
To describe the safety and efficacy of nitrous oxide during ketamine administration for the
prevention of emergence reaction during Emergency Department procedural sedation and
analgesia in adults. Drugs such as fentanyl, midazolam, and propofol are widely used in
emergency departments for procedural sedation and analgesia because they have a rapid onset
and short duration of action. Unfortunately, all of these agents may cause respiratory
depression, particularly when combined with other sedative agents, administered in large
doses, or given to patients with underlying respiratory diseases. Nitrous oxide use during
ketamine administration may be an ideal combination for the prevention of emergence reaction
in adults sedated in the ED. Like ketamine, nitrous oxide has an excellent cardio-respiratory
profile as well as some analgesic and anxiolytic qualities. The anxiety and pain surrounding
procedural sedation is not limited to the procedure itself, but the elapsed time from the
time the patient enters the ED to the time spent in preparation for the procedure can be
significant and lead to increased anxiety, which may exacerbate emergence reactions in
adults. Using nitrous oxide before ketamine administration may mitigate this. While midazolam
has shown efficacy in reducing emergence reactions in adults sedated with ketamine, the
investigators believe that inhaled nitrous oxide may be equivalent to midazolam, with a
better cardio-respiratory profile.