Colorado anesthesiology organization calls for suspension of ketamine program

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DENVER, Colo. (KDVR)— The Colorado Society of Anesthesiologists is calling for the state health department to suspend the state waiver program that allows paramedics to sedate patients with ketamine in cases of an extremely agitated condition, excited delirium, while the state reviews the program.

CDPHE to review state ketamine waiver program

“The Colorado Society of Anesthesiologists (CSA) has great concern about the use of the anesthetic agent ketamine for the treatment of “excited delirium” by EMS personnel regulated by the Colorado Department of Public Health and Environment (CDPHE),” the group said in a Tuesday statement.   “Our concern stems from the reported large number of uses of ketamine for this purpose in the past 2 1/2 years (more than 902 uses), reported doses that are equal or greater to that used to produce general anesthesia, and the high reported complication rate (24% in 2019 including at least one death).”

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The state health department announced in August that it would review the program that provides waivers to medical directors, allowing agencies to administer the drug after recent questionable incidents, including the case of Elijah McClain, who died after receiving the drug and after struggling with police officers,  were brought to the state’s attention. A coroner could not determine the cause of McClain’s death.

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“Our agency will work with medical experts to study the use of ketamine in the field– as well as the state’s oversight mechanisms– and produce a public report. Patient safety and program transparency are top priorities,” said Jill Hunsaker Ryan in an August statement.

The Colorado Society of Anesthesiologists is asking CDPHE to include “unconflicted outside experts including anesthesiologists, psychiatrists, and public members,” in its review.  “This review should include indications for use including the ethics and legal authority for chemically restraining individuals against their will, dosing monitoring after administration, and determining an acceptable complication rate.

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“Independent of the ‘excited delirium’ diagnosis, use of chemical incapacitation to treat agitation is demonstrably hazardous given the CDPHE data on complication rate associated with ketamine administration.  The use of anesthetics like ketamine should be used only as a last resort, in appropriate doses, only if the individual is an immediate and severe threat to themselves or others, and only if there is public acceptance of this technique,” said CSA.

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