Dissociative anesthesia in a prehospital environment
© BioMed Central Ltd 2007
Published: 19 June 2007
Dissociative anesthesia is usually performed in a hospital setting. The advantages of ketamine are respiratory and hemodynamic stability, low price and worldwide availability. Its use in the emergency room is safe, but use in a prehospital environment is less known and less reported.
To analyze the safety and complications of dissociative anesthesia guided by an institutional protocol in a prehospital environment.
A retrospective, observational series, protocol-driven study with dissociative anesthesia with ketamine plus midazolan from 1998 to 2004 (excluding 2000, because no available data). All patients were attended by an urban advanced life support unit.
Variable comparison between groups 1 and 2
Number of patients
Glasgow Coma Score mean score
Oxygen saturation mean values (%)
Revisited Trauma Score mean values
Revisited Trauma Score = 12 (%)
36.8 (n = 7)
77.5 (n = 53)
Revisited Trauma Score ≤11 (%)
63.2 (n = 12)
22.5 (n = 16)
Agitation before dissociative anesthesia (%)
31.6 (n = 6)
7.24 (n = 5)
Inferior and superior extremity fractures, open and closed (%)
26.31 (n = 5)
47.8 (n = 33)
Prehospital orotracheal intubations (%)
10.52 (n = 2)
2.89 (n = 2)
Prehospital surgical airway
Prehospital cardiorespiratory arrest
Dissociative anesthesia is a safe procedure even in a prehospital environment when performed in a group of patients with GCS 14 or 15 after implementation of an institutional protocol. Proficiency in definitive airway techniques is necessary. Improvement in the quality of attendance and humanization of the EMS are best performed by introducing analgesia protocols into the prehospital environment.