Procedural sedation in the emergency department: a randomized trial of ketamine versus etomidate

• Mohamed Kilani

  urgent medical assistance emergency department

• Khedija Zaouche

• Manel Kallel

• Emna Rezgui

• Emna Kallel

• Fedia El Ayech

• Camilia Jeddi

Introduction: Pain management, especially pain related to medical procedures, is a major concern for emergency  physicians. While several drugs have proven effective, no single agent is considered ideal. This  study aimed to compare the efficacy of Etomidate and Ketamine in preventing procedure-related pain in the emergency department (ED).

Methods: We conducted a prospective, randomized, single-center study over six months. The study included patients over 18 years old who required a painful medical procedure in the ED. Patients were randomly assigned to receive either a bolus of 0.1 mg/kg Etomidate or 0.5 mg/kg Ketamine. The primary outcome was a hybrid criterion: absence of awakening during the procedure and rapid recovery within 10 minutes.

 Results: A total of 55 patients were enrolled, 25 in the Etomidate group and 30 in the Ketamine group. Four 15 patients experienced awakening during the procedure: three in the Etomidate group and one in the Ketamine group (p=0.3). The mean recovery time was 13.01 ± 3.7 minutes in both groups (p=0.26). Side effects occurred in 63.6% of patients (p=0.79). Complete recall of the painful procedure was reported in seven patients, six of whom were in the Etomidate group (p=0.03).

Conclusion: Ketamine does not appear to provide a significant advantage over Etomidate for procedural sedation in the ED. However, awakenings during the procedure were more frequent with Etomidate

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