Perceptual Disturbances (Illusions) Due To Low Dose Ketamine In Emergency Department

Abstract

Background: In emergency rooms, ketamine is commonly used as a low dose analgesic because it has a fast onset, is hemodynamically stable, and opioid sparing. Nevertheless, at sub-dissociative dosage, ketamine is capable of causing perceptual disturbance and dissociative experiences that can impact patient comfort, communication and overall care experience. Very little research has been done on varying regimens of low dose ketamine in relation to the level of these perceptual disturbances. This research was intended to assess the frequency and degree of occurrence of perceptual disturbances and to identify the relationship between the dose of ketamine and the incidence of dissociative symptoms in emergency patients. Methods: The study was a cross-sectional observational study on 108 patients (adults) undergoing low doses of ketamine (0.1 mg/kg or 0.3 mg/kg) as an anaesthetic’s agent in the emergency room. The perceptual disturbances such as sensory illusions, body perception, cognitive disconnection, and memory effects were measured with the help of an organized questionnaire. The overall disturbance patterns were summarized with the help of descriptive statistics, whereas the correlation between the dose of ketamine and the severity of perceptual effects were analyzed with the crosstabulation and chi-square tests. Results: The level of perceptual disturbance was widespread in the sample as the majority of the patients reported at least one type of dissociative or sensory alteration. The most pronounced dose-related differences were in 10 out of 11 disturbances that had been measured. The moderate to severe symptoms that were more prevalent among patients who were treated with 0.3 mg/kg included feeling of unreality, being disconnected, floating, disorienting, uncontrollable, and memory lapses (p < 0.05). There was no significant correlation between dose and only misinterpreted sounds (p = 0.576). On the whole, the results showed that there was a definite dose-response correlation, and the high low-dose regimen produced stronger perceptual effects. Conclusion: Ketamine low dose is a good analgesic, which is linked to dose-related perceptual disturbances in emergency department patients. Most of the symptoms were mild and non-hazardous; however, the 0.3mg/kg dose always had more severe dissociative effects compared to the 0.1mg/kg dose. These findings should be used by clinicians in choosing doses, preparing patients to expect perceptual experiences, and watching out the symptoms of dissociation in the course of care. The findings also emphasize the need to balance between analgesic effect and patient comfort, and safety in the case of low-dose of ketamine.