Evaluation of ketamine dosing at a rural, community hospital in the emergency department and intensive care unit

Abstract Background Ketamine is a versatile anaesthetic and analgesic often used in emergency departments (ED) and intensive care units (ICU). Ketamine requires weight‐based dosing for both adult and paediatric patients which makes accurate dosing challenging, particularly in emergent settings. Aim The aim of this drug utilisation evaluation (DUE) was to assess the appropriateness of ketamine dosing in the ED and ICU at a rural community hospital in Montana, USA. Method A retrospective chart review of patients who received ≥1 dose of ketamine from 1 January 2022–1 October 2023. The primary objective was to evaluate the appropriateness of dosing, according to 2023 Lexicomp recommendations. Secondary outcomes included dosing by location, indication, and patient population. The total number of ketamine doses administered was analysed using frequency distributions. Results were expressed as both counts and percentages. Ethical approval was granted by the Intermountain Institutional Review Board, Privacy Board (Reference no: 1052659) and the study conforms with the Declaration of Helsinki. Results One hundred eighty‐seven patients received 219 doses of ketamine from 1 January 2022–1 October 2023. The majority of doses were appropriate (total: 87.2%; ED: 85.0%; ICU: 94.2%). The majority (86.7%) of ketamine doses per indication were appropriate. Doses administered to paediatric patients were appropriate 100% of the time, 85.4% of doses were appropriate in adult patients, and and in patients with obesity, doses were appropriate 80.3% of the time. Conclusion Over a period of 21 months, 87.2% of ketamine doses were administered appropriately in an emergency setting, demonstrating an overall caution with usage. Optimal dosing strategies depend on the clinical indication, with dissociative doses (1–2 mg/kg) providing rapid induction. Careful titration and monitoring for adverse effects are essential to maximising efficacy and safety. Standardised protocols and further research are needed to refine dosing strategies and optimise patient outcomes.