Question: Pharm

E) Despite the news stories, ketamine is a very safe drug for pediatric procedural sedation. Absolute contraindications include < 3 months of age and psychosis. Although ketamine was purported to raise intraocular and intracranial pressures, recent literature does not show this effect to be clinically significant, and elevated IOP or ICP are not absolute contraindications to use, although they remain as contraindications on many hospital policies. Ketamine is now being used to treat chronic pain as an opioid-sparing drug, agitated delirium, depression, and benzodiazepine-resistant alcohol withdrawal. Recreational use is rising, is much more common in East Asian countries, and because powder forms of ketamine are more popular, fentanyl contamination is an issue. Ketamine-associated laryngospasm and apnea occur idiosyncratically and are not dose-dependent. Per news reports, the ketamine in Matthew Perry’s system was not due to his therapeutic infusion (which was 2 weeks prior to his death), and ketamine use in a spa led to drowning as a contributor to his death. Also per news reports, the paramedics who treated Elijah McClain significantly overestimated his weight and did not personally confirm the indication (agitated delirium); they gave 500mg of ketamine IM based on police officers’ assessment.