title: High-Dose Sedation and Analgesia During Extracorporeal Membrane Oxygenation: A Focus on the Adjunctive Use of Ketamine.
abstract: Use of ketamine in patients requiring extracorporeal membrane oxygenation (ECMO) has rarely been reported, and the optimal dosing strategy remains unclear. A patient admitted with hypoxic respiratory failure required ECMO in addition to continuous infusion of low-dose ketamine following titration of opioid and sedative medications to high doses. After initiation of ketamine, infusion rates of opioids and/or sedatives were maintained or decreased. Recorded Richmond Agitation-Sedation Scale (RASS) scores were -4 to -5 and documented pain scores were 0. No adverse effects were reported while receiving low-dose ketamine. This case illustrates that use of low-dose ketamine infusion may be a useful adjunctive agent in patients receiving ECMO and high-dose opioid and sedative medications.
authors: Catherine K
authors: CK
authors: Floroff
authors: Tanna B
authors: TB
authors: Hassig
authors: Joel B
authors: JB
authors: Cochran
authors: Joseph E
authors: JE
authors: Mazur
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives; D000860:Hypoxia / Q000628:therapy; D007649:Ketamine / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D007649:Ketamine
keywords: Analgesia; H1N1 influenza A; extracorporeal membrane oxygenation; hypoxic respiratory failure; influenza; ketamine; sedation