Association of ketamine use during procedural sedation with oxygen desaturation and healthcare utilisation: a multicentre retrospective hospital registry study
Authors' conclusion
Ketamine use for procedural sedation was associated with an increased risk of oxygen desaturation and discharge to a nursing home. The effect was dose-dependent and magnified in subgroups of vulnerable patients.
Study context
- Population
- Adults undergoing procedures under MAC by anaesthetists, 2005–2021, two academic healthcare networks, US
- Participants
- 234,170 adults
- Exposure
- Ketamine vs no ketamine during procedural sedation
- Outcome
- Intraprocedural oxygen desaturation (SpO2 <90% for ≥2 consecutive minutes); co-primary: nursing home discharge
Methodological detailsmulticentre, hospital registry
- Multicentre
- Hospital registry
Main finding
As reported in the abstract
Intraprocedural oxygen desaturation
Each group vs no ketamineAdjusted odds ratio (95% CI)P value
Ketamine
1.22(1.15–1.29)
P < 0.001Each group vs no ketamineAdjusted absolute risk difference (95% CI)P value
Ketamine
1%(0.7–1.3%)
P < 0.001Observational data: associations, not effects.
Further findings
| Outcome | aOR (95% CI) | P value | |
|---|---|---|---|
| Nursing home discharge (co-primary)Ketamine vs No ketamine | 1.11 (1.02–1.21) | P = 0.012 | |
| Desaturation, age >65 yr, smoking or preprocedural ICU admission (subgroup)Ketamine vs No ketamine | 1.35 (1.25–1.45) | P < 0.001 | |
| Desaturation, upper endoscopy longer than 2 h (subgroup)Ketamine vs No ketamine | 2.91 (1.85–4.58) | P < 0.001 | |
| Desaturation, ketamine >0.5 mg kg-1 (dose)Ketamine >0.5 mg kg-1 vs No ketamine | 1.61 (1.43–1.81) | ||
| 0.20.5125Adjusted odds ratio (log scale) |
| Outcome | Adjusted absolute risk difference (95% CI) | P value | |
|---|---|---|---|
| Nursing home discharge (co-primary)Ketamine vs No ketamine | 0.25% (0.05–0.46%) | P = 0.014 | |
| Desaturation, age >65 yr, smoking or preprocedural ICU admission (subgroup)Ketamine vs No ketamine | 2% (1.56–2.49%) | P < 0.001 | |
| Desaturation, upper endoscopy longer than 2 h (subgroup)Ketamine vs No ketamine | 16.2% (9.8–22.5%) | P < 0.001 | |
| −100102030Difference (linear scale) |
- Desaturation, age >65 yr, smoking or preprocedural ICU admission (subgroup): P-for-interaction <0.001
- Desaturation, upper endoscopy longer than 2 h (subgroup): P-for-interaction <0.001
- Desaturation, ketamine >0.5 mg kg-1 (dose): P-for-trend <0.001
Desaturation, concomitant opioid
- Concomitant opioid administration mitigated the risk
- P-for-interaction <0.001
Original publication
Association of ketamine use during procedural sedation with oxygen desaturation and healthcare utilisation: a multicentre retrospective hospital registry study. Br J Anaesth. Published 11 December 2023. doi:10.
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