Meets discharge criteria?
Consider equipment failure, possible need for increased ketamine dose
Apply monitoring equipment
Place IV (if possible)
Morphine
Obtain informed consent
Features of a difficult airway
Lemon © mneumonic
Contraindications to ondansteron?
Patient adequately sedated?
Preform procedure
Discharge
Meets NPO criteria?
ASA classification appropriate for sedation?
Risk of difficult airway appropriate for sedation?
IM route required?
Wait for appropriate times if possible
Emergent need for sedation?
Apply as many non-emergent sedation practices as possible, consider NG/OG tube to evacuate stomach contents, consult advanced airway practitioner if possible
Sedation goals:
Contraindications to ondansetron
1.5 mg/kg IV
Pre-procedure checklist
Complications
Increased intracranial pressure
Consult advanced airway practitioner
Midazolam premedication
Ketamine-induced neuroapoptosis
Anticholinergic premedication
Discharge criteria
Consult advanced airway practitioner
ASA classification
NPO criteria
Of note, there are very, very few cases of aspiration during ketamine sedation with and without waiting for the above NPO times. Ketamine maintains airway/swallowing reflexes making the risk of aspiration low even with disassociation and occasional vomiting. Emergent procedures should, of course, not be delayed for NPO times. However, if waiting for NPO status is otherwise a judgment call for procedural sedation with ketamine.