SCCM Resource Library-Drug Shortage Alert: Parenteral Ketamine

Pdf Summary

Parenteral ketamine is currently experiencing a shortage due to increased demand, shortages of the active ingredient, and manufacturing delays. This alert provides recommendations and information for managing the shortage and its impact on adult patients. Some potential strategies include reserving ketamine for specific scenarios such as endotracheal intubation, pain control, refractory status epilepticus, and agitated delirium. It is important to assess the supply at each institution and choose alternative agents when appropriate.<br /><br />For endotracheal intubation, ketamine and etomidate are commonly used sedatives to mitigate hemodynamic derangements, but ketamine may be preferred in patients with shock to avoid adrenal suppression. Ketamine can also be effective in pain control, especially in patients with a history of polysubstance abuse and opioid use disorder. In refractory status epilepticus, ketamine may be used to decrease seizure burden in patients who have not responded to other therapies. Agitated delirium unrelated to uncontrolled pain can be managed with intramuscular ketamine for sedation.<br /><br />The table provided in the alert outlines potential management strategies for critically ill adult patients in various indications. The use of ketamine and the choice of alternative agents should be based on the specific indication and evaluated on a daily basis. Safety implications include educating staff and caregivers when alternative agents are used to prevent adverse reactions. It is also important to double-check ketamine doses and prepare them accurately to minimize the risk of errors.<br /><br />Overall, the impact of the ketamine shortage on ICU care includes the need to optimize nonpharmacologic and multimodal regimens for pain management, careful selection of sedative agents for mechanically ventilated patients, and considering alternative therapies for asthma exacerbation and alcohol withdrawal. It is recommended to monitor the daily use of ketamine and assess its appropriate use.

Asset Subtitle

Pharmacology, Crisis Management, 2023, 0:02:00

Meta Tag

Content Type Article

Knowledge Area Pharmacology

Knowledge Area Crisis Management

Membership Level Nonmember

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Resource Allocation

Tag Analgesia and Sedation

Year 2023

Keywords

Parenteral ketamine

shortage

increased demand

alternative agents

pain control

refractory status epilepticus

agitated delirium

sedatives

critically ill adult patients

ICU care

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