In this study, we will compare the safety and effectiveness of ketamine and propofol in sedating acute psychiatric patients needing aeromedical retrieval. We believe that this is the first trial of its kind which will elucidate the complications, the safety profile and effectiveness of the two drugs in sedating acute psychiatric patients. The study will be a prospective, open-labelled, randomised controlled trial. Patients will be drawn the Northern Territory and Queensland. Through this study, we will better inform clinicians in their choice of a suitable sedation agent and potential provide an additional sedation choice in aeromedical and other critical care environments. Furthermore, this research has the potential to establish sedation guidelines in the aeromedical retrieval of acute psychiatric patients for Australia and internationally.
Read MoreResearch by Australian toxicologists raises the possibility of sedating violent patients in emergency departments with the anaesthetic, ketamine. The research team looked at using the drug on patients who hadn’t responded to front-line treatments. While ketamine is normally given to patients undergoing surgery, the team showed using ketamine intramuscularly was also highly effective for the rapid […]
Read MoreThe research aim is to conduct as a randomised clinical trial comparing the use of Ketamine and Propofol in sedating acute psychiatric patients for safe aeromedical retrieval. The inherent dangers of the aviation environment combined with the potential and unpredictable behaviour of acute psychiatric patients presents a challenge to even the most experienced aeromedical retrieval clinician. An efficacious sedation drug is vital in this environment to ensure patient and crew safety and to minimise patient distress. The outcomes of this research will highlight the potential complications, the safety profile and efficacy of different sedation agent utilised in the sedation of acute psychiatric patients in the aeromedical retrieval setting. This research has the potential to establish sedation guidelines in the aeromedical retrieval of acute psychiatric patients for Australia and internationally.
Read MoreChildren present to emergency departments (EDs) with injuries that require painful procedures such as straightening broken bones and suturing cuts. Medicines used for these procedures include midazolam (a sleeping medicine), nitrous oxide (laughing gas), and morphine (pain killer) as well as many others. Ketamine is one medicine that combines pain relief and sedation. Ketamine is very safe and has been used in millions of procedures around the world. Children when they wake up after ketamine may be agitated or feel like vomiting. Ketamine can raise blood pressure and some situations it should not be used. Ketamine is Australia’s preferred sedative for children in EDs. Perhaps we can improve on ketamine by using different dosing methods or mixing with other medicines.
Propofol is another medicine used to deeply sedate children. In large amounts it will interfere with breathing and lower blood pressure, so it needs to be given in the right place and at the right time. Propofol’s main advantage is that it is much faster to work than ketamine and its effects wear off very fast. Interestingly when propofol is given with ketamine they may balance each other’s side effects; keeping blood pressure even, providing relaxation, reducing vomiting. Since propofol recovery is faster than ketamine, children may wake up sooner.
Emergency doctors have been mixing ketamine and propofol together and calling this combination “ketofol” and find it very effective in adults. Some give ketamine and then propofol, although how much is required is not clear. A number of emergency doctors prefer to give ketamine alone and treat side effects if they occur.
Sick and injured children in the Emergency Department (ED) often require procedures which can cause severe pain (like fracture reduction, stitching wounds, abscess drainage) or otherwise require the child to be still and cooperative (CT scans, lumbar punctures, removal of foreign bodies). Sedative drugs are given to these patients both to relieve pain/distress and to keep them still for the procedure.
ED sedation of children now has a well established body of evidence. Most of the literature relates to when the drug is given intravenously or intramuscularly. Drug delivery by these routes leads to reliable effects as the drug bypasses the liver without being broken down before it reaches the brain. However, both these routes require a needle which requires staff to hold down a young child against their will, frequently causing great distress along with the pain of the needle. Great efforts have gone into making EDs "Ouchless" where unnecessary pain for children is reduced or eliminated. Sedation is itself part of this effort. The intranasal route (injecting the medicine up the nose with a plastic syringe) could represent a needle-free alternative.
Ketamine is the most common drug used for paediatric sedation in Australian EDs and can be given intranasally. No studies have examined its use for ED sedation but many studies support its use in anaesthetics and dental clinics where it has been shown to be safe and effective.
Read MorePain is a common feature of major traumatic injuries. Little research has been done into the utilisation of low dose Ketamine for analgesia in the ED. Ketamine has the potential to be a highly effective method of analgesic management in haemodynamically unstable trauma patients who are unsuitable for large doses of opioid drugs but it is not utilised for this purpose due to a lack of supporting evidence and clinical concern about potential side effects. The clinical impact of this trial is in the development of an evidence base to support the use of Ketamine for analgesic purposes in the ED. Our hypothesis is that low-dose Ketamine provides effective (statistically significant reduction in pain score), safe (low rates of emergence and adverse events) and tolerable (patient reported effects/willingness to use again) analgesia when used in sub-anaesthetic doses in patients with traumatic injuries. If proven this will have significant implications for the clinical care of patients and in pain management guidelines with traumatic injuries in the ED.
Read MoreMental illness affects 1 in 5. With most people only likely to attend hospital during a crisis, specialised mental healthcare is vital in emergency departments.
Read More26 April 2019 Gold Coast Health Emergency Specialist, Dr Megan King and her team have been awarded a $60,000 Emergency Medicine Foundation grant to look at how to improve the sedation experience in children. Dr King, who works in the children’s emergency department at Gold Coast University Hospital, says it’s all about making children as […]
Read MoreQueensland paramedics are leading the world by introducing a new drug, droperidol, to quickly and safely calm violent patients fuelled by alcohol and drugs. With backing from the Emergency Medicine Foundation (EMF) Australasia, the Queensland Ambulance Service (QAS) has also conducted the world’s first comparison of the standard sedative, midazolam, with droperidol in a prehospital […]
Read MoreAbout the Rural and Remote Research Program The Rural and Remote Research Program supports collaborative research projects in the field of emergency medicine to improve patient outcomes in Australian rural and remote locations. Through this grants program, EMF awarded funding to three innovative research projects. Implementation of Nasal High Flow: A Remote Context. This […]
Read More