Dr. Peter Antevy explains that diluting ketamine in saline and infusing it over 15 minutes cuts dissociative effects and agitation compared to a concentrated IV push. A 2015 study found the infusion group had zero unreality and agitation scores versus bothersome dissociation and light sedation in the push group.
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Hi, everyone. My name is Dr. Peter Hentevi. Welcome to another edition of the Hentevi Minute. And today I want to talk about one of my favorite topics, which is ketamine for pain. You may be using this or you may be thinking about doing it. It turns out there's a better way of doing it. If you're going to do it, there's two options.
One is to give it over 15.
Minutes in a 100cc saline bag. We'll talk about that in a minute. Or what most people do today is they actually just take the drug and they push it directly into the iv, oftentimes with a very concentrated version of ketamine. Well, there was a study done in.
2015 that looked at this 24 patients in each group. And it turns out that the infusion.
Group, the 15 minute group, had much.
Better outcomes than the slow IV push. So when they looked at these two scales, one is actually a scale where.
They asked for a feeling of unreality.
And it turns out that this group, the slow IV push, had a very.
High score of 3, which is a bothersome value. Basically, they felt really bothered by it.
And then they looked at the agitation score and the score here came to.
A score of -2, which is basically light sedation. So you're causing them to kind of not dissociate completely, but somewhat.
And then when you looked at the.
Other group here, the infusion, those other 24 patients, the score on the feeling of unreality was zero, and the agitation score was another zero.
Turns out that the pain was managed exactly the same in both groups.
But you could see here that giving.
It slowly kept your patient awake and happy, not bothered and not sedated. And so now I want you to.
Take a look at how would it look for a pediatric patient.
So I want you to take a look here. This is Polk County Fire Rescue and they have the Entevi mobile and they.
Use ketamine for pain.
And you can see here for a five year old, that the dose as a volume using the 10 milligram per milliliter concentration is 0.5 ML. So let's take a look at that and see how that would look using an IV bag. Okay, so here's the ketamine and the folks in Polk county, as you saw, carry 10 milligrams per milliliter. And for that patient it was 0.5 mls. So essentially take a 1 cc syringe.
And you're going to load it up.
With 0.5 mls.
Of the ketamine. Green ketamine, that is.
And then you simply insert it into the bag.
And now you have your dose of.
Ketamine in the 100cc bag and you.
Let that run in over 15 minutes.
And that way you have age appropriate.
Dosing of ketamine and you have a mechanism where when you bring a child.
Into the er, you'll have a child.
Who'S not sedated, who's not feeling bothered.
But who has significant pain relief.
I'll have those studies up on the website as well. So, again, happy St. Patrick's Day, everyone.
And this is Dr. Peter Entevi for another edition of the Hen Tevi Minute. Thank you.
