Background: Acute agitation in behavioral emergencies, stemming from psychiatric disorders, substance intoxication, or medical issues can be greatly concerning to health professionals working in emergency departments (EDs). Safe, rapid, effective sedation is crucial to providing a safe environment for both the patient and staff in the ED setting. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has gained increasing popularity in EDs as a treatment option because of its rapid onset of action, minimal respiratory depression, and cardiovascular stability. Aim: This narrative review aimed to bring together literature around ketamine's use for acute agitation in the ED, as well as the efficacy, safety, clinical applications, and challenges to implementation as it relates to dosing, routes of administration, and comparison with standard agents. Methods: This narrative review included 60 peer-reviewed articles published from 2010-2024 sourced from PubMed, Scopus, Web of Science and reference lists. The studies included randomized controlled trials (RCTs), observational studies, meta-analyses, and case series on adults (≥ 18 years) experiencing acute agitation with ED presentations. Results: Ketamine (4–5 mg/kg IM or 1–2 mg/kg IV) achieved sedation within 5–10 mins in 85–90% of cases, with improved efficacy over benzodiazepines and antipsychotics based on speed and consistency. Adverse events including hypoxia (10-12%) and psychomimetic effects (5-15%) were manageable. Ketamine performed well in substance induced agitation and agitation in patients with benzodiazepine histories. Conclusion: Ketamine is a efficacious and safe approach for acute agitation, especially in difficult cases. Written protocols, educational training, and ethical guidelines are needed for appropriated management.
A Mon, study studied this question.