• Justin Lin, Yelena Figuerado, Adrienne Montgomery, Jonathan Lee, Mark Cannis, Valerie C Norton, Richard Calvo, and Harminder Sikand.
• Scripps Mercy Hospital Department of Pharmacy, 4077 5th Ave, MER 52, San Diego, CA 92103, United States of America. Electronic address: Lin.Justin@scrippshealth.org.
• Am J Emerg Med. 2021 Jun 1; 44: 306-311.

BackgroundClinicians often encounter agitated patients, and current treatment options include benzodiazepines and antipsychotics. Ketamine rapidly induces dissociation, maintains cardiovascular stability, spontaneous respirations, and airway reflexes. There are no prospective, randomized studies comparing ketamine to other agents in the initial management of acute agitation in the Emergency Department (ED).ObjectiveDetermine the efficacy and safety of ketamine compared to parenteral haloperidol plus lorazepam for initial control of acute agitation.MethodsThis study was a prospective, single-institution, randomized, open-label, real world, standard of care pilot study. Adult patients with combative agitation were randomized to ketamine (4 mg/kg IM or 1 mg/kg IV) or haloperidol/lorazepam (haloperidol 5-10 mg IM or IV + lorazepam 1-2 mg IM or IV). The primary outcome was sedation within 5 min, and secondary outcomes included sedation within 15 min, time to sedation, and safety.ResultsNinety three patients were enrolled from January 15, 2018 to October 10, 2018. Significantly more patients who received ketamine compared to haloperidol/lorazepam were sedated within 5 min (22% vs 0%, p = 0.001) and 15 min (66% vs 7%, p < 0.001). The median time to sedation in patients who received ketamine compared to haloperidol/lorazepam was 15 vs 36 min respectively (p < 0.001). Patients who received ketamine experienced a significant, but transient tachycardia (p = 0.01) and hypertension (p = 0.01).ConclusionIn patients with combative agitation, ketamine was significantly more effective than haloperidol/lorazepam for initial control of acute agitation, and was not associated with any significant adverse effects.Copyright © 2020 Elsevier Inc. All rights reserved.

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