Ketamine compared with other sedatives during rapid sequence intubation (RSI) in critically ill patients shows no significant difference in in-hospital mortality, physiological function, or adverse events. A systematic review and meta-analysis of 15 studies (5 randomized controlled trials and 10 cohort studies) involving 16,807 participants found no overall mortality benefit (odds ratio 0.90, 95% confidence interval 0.72 to 1.12). Low-quality evidence suggests ketamine may reduce mortality within the first seven days of hospitalization (odds ratio 0.42, 95% confidence interval 0.19 to 0.93) but may also prolong intensive care unit stay (mean difference -0.71 days free of ICU at day 28, 95% confidence interval -1.38 to -0.05).
Among children aged 2–14 years receiving ketamine for procedural sedation in the emergency department, pre-procedural anxiety was not associated with vomiting. Vomiting occurred in 23 of 93 children (about 25%), with most episodes happening in the hospital. Anxiety scores averaged 58.3 in those who vomited and 51.0 in those who did not. Statistical analysis showed no significant relationship between anxiety level and vomiting, with an adjusted odds ratio of 1.03 (95% confidence interval 1.0–1.05) that was borderline significant. The findings suggest that anxiety before the procedure does not meaningfully predict vomiting in this setting.