However, there are no standardized clinical research practice guidelines and its incidence varies considerably with the assessment tool or definition used. Several tools are available for assessing EA. If preoperative or intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce its adverse consequences. The proposed risk factors of EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood–gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. Although providers must be prepared to recognize and manage airway obstruction, cardiorespiratory adverse events are rare and typically do not affect outcomes.Emergence agitation (EA), also referred to as emergence delirium, can have clinically significant consequences. When ketamine is used for procedural sedation in adults, emergence phenomena occur in 10% to 20% of patients. Dysphoric emergence phenomena occur in 10% to 20% of cases sedating medications are effective in preventing and managing these reactions. Reports of significant cardiorespiratory adverse events are rare, despite ketamine's frequent use in austere, poorly monitored settings. Laryngospasm and airway obstruction are reported, and though ketamine is a respiratory stimulant, a brief period of apnea around the time of injection is common. Pharyngeal reflexes are generally preserved and cardiovascular tone stimulated, including a rise in blood pressure and myocardial oxygen demand. Ketamine reliably produces conditions that facilitate the performance of painful procedures. Contexts, end points, and methodological quality varied widely across studies. Most studies were performed in the 1970s and published in the anesthesia literature. Of the 5512 unique citations that were evaluated, 87 met criteria for inclusion. Studies that met inclusion criteria were abstracted onto structured forms and their results qualitatively summarized. Inclusion criteria included adult study ketamine used to facilitate the performance of painful procedures dose of at least 1 mg/kg intravenous or at least 2 mg/kg intramuscular original data and adverse events reported spontaneously breathing patient, and no continuous cotherapies. Experts were contacted to locate additional data. PubMed, EMBASE, TOXNET, and a variety of specialized databases were queried without regard to publication date or language. We performed a literature review based on adverse effect research methodology recommendations. Our objective was to determine ketamine's adverse effect profile in adults when used for procedural sedation. However, adult data on ketamine use in the emergency medicine literature are sparse. Emergency physicians use ketamine infrequently in adults, as it is believed to have a more significant side effect profile in this population. Ketamine is widely used as a procedural sedation agent in pediatrics, where its safety and efficacy are supported by numerous studies.
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