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CRITICAL CARE AND TRAUMA

Ketamine for Long-Term Sedation and Analgesia of a Burn Patient

Thomas Edrich, MD PhD^*, Andrew D. Friedrich, MD^*, Holger K. Eltzschig, MD^*,, and Thomas W. Felbinger, MD^*

*Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; and Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany

Address correspondence and reprint requests to Thomas W. Felbinger, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115. Address e-mail to tfelbinger{at}partners.org

We present a case in which ketamine was used for long-term sedation and analgesia of a burn patient. Under escalating opiate dosages, the patient had developed persistent ileus as well as abdominal distension that caused respiratory compromise, without receiving sufficient analgesia. The opiate-sparing effect of the continuous ketamine infusion was more than 90%. The ileus resolved within 24 h. The quality of sedation also changed favorably. There were no obvious adverse effects of ketamine.

IMPLICATIONS: The care of critically ill burn patients can be challenging because of a rapidly escalating tolerance for opioids. In this case, a large-dose ketamine infusion was useful for both analgesia and sedation. It significantly reduced the opioid requirement and overcame the adverse effects of opioids.