PHARM - By ketaminh - February 28, 2016
..."Folks who dont have droperidol, often say that midazolam ( I call it midazoslap or midazoslam, depending on dosing) is the ideal agent for sedation for this patient group.
I am not going to say that midazolam is not effective. I am going to say it can be too effective . So effective that it will stop agitation completely by inducing apnoea and airway loss. It doesnt last long and so repeated dosing is often needed. THis then can lead to accumulation of the drug and the threshold for respiratory complications can get quickly reached.
But this article is not about saying ketamine is better than midazolam nor vice versa. THis is about reviewing the safety and efficacy of ketamine sedation in the psychostimulant intoxicated patient, in case you get a situation that may be assisted with ketamine and you want to know the evidence base and current practice globally.
Conclusion: I use ketamine sedation in cases of psychostimulant intoxication as a second line agent, after droperidol sedation has not achieved sufficient effect. In the highly violent patient, I choose ketamine sedation as first line to establish rapid control with relative safety profile."