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Ketamine for Sedation During Bronchoscopy Procedures: A Review of Clinical Effectiveness, Safety, and Guidelines

Last updated: August 17, 2020
Project Number: RC1298-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness and safety of ketamine for sedation during bronchoscopy procedures?
  2. What are the evidence-based guidelines for the use of ketamine for sedation during bronchoscopy procedures?

Key Message

Six relevant publications were identified. These comprised one systematic review, two randomized controlled trials and three non-randomized studies (one prospective single-arm study, and two retrospective studies). Various drugs, including ketamine, propofol, midazolam, fentanyl, and/or their combinations, were used for sedation for the bronchoscopy procedures.There were no significant differences in recovery time, or in the proportion of patients experiencing hypoxia, for adult or pediatric patients between sedative drug combinations that included ketamine and alternative procedural drugs.Sedative drug combinations including ketamine were associated with statistically significantly higher mean arterial pressure and a higher proportion of patients experiencing high blood pressure compared with alternate sedative combinations in adults undergoing bronchoscopy. Also, the number of pediatric patients requiring mask ventilation was statistically significantly greater in the group receiving a sedative drug combination including ketamine compared with an alternate sedative combination. The proportion of pediatric patients experiencing bronchospasm and emergence agitation was numerically higher with ketamine compared with propofol.Findings regarding hypotension and desaturation were inconsistent.Findings need to be interpreted with caution considering there is limited number of studies evaluating specific sedation procedures with ketamine for patients undergoing bronchoscopy and overall low quality of the body of evidence.No evidence-based guideline was identified hence no summary could be provided.