Ketamine for palliative sedation in the emergency department

J Emerg Med. 2013 Feb;44(2):355-7. doi: 10.1016/j.jemermed.2012.08.026. Epub 2012 Oct 6.


Background: Palliative sedation to treat severely distressing symptoms in those with a poor prognosis is well-accepted.

Objective: We discuss palliative sedation in the Emergency Department and the use of ketamine.

Case report: We present the case of a patient with angioedema of the tongue and severe respiratory distress. The patient's nursing home was unable to control her symptoms and she was transferred to the Emergency Department. The patient received fentanyl 50 μg i.v. and ketamine 50 mg i.v. every 5 min until adequate palliative sedation was achieved.

Conclusion: Ketamine can be considered for Emergency Department palliative sedation in selected patients. Identifying and caring for unmet palliative care needs is an important skill for Emergency Medicine.

Publication types

  • Case Reports

MeSH terms

  • Advance Directive Adherence
  • Aged, 80 and over
  • Airway Obstruction / etiology
  • Anesthetics, Dissociative / therapeutic use*
  • Anesthetics, Intravenous / therapeutic use
  • Angioedema / complications
  • Dyspnea / etiology
  • Dyspnea / therapy
  • Emergency Service, Hospital*
  • Fatal Outcome
  • Female
  • Fentanyl / therapeutic use
  • Humans
  • Ketamine / therapeutic use*
  • Nursing Homes
  • Palliative Care*
  • Respiratory Distress Syndrome / complications
  • Respiratory Distress Syndrome / therapy
  • Tongue Diseases / complications


  • Anesthetics, Dissociative
  • Anesthetics, Intravenous
  • Ketamine
  • Fentanyl