Association of ketamine use during procedural sedation with oxygen desaturation and healthcare utilisation: a multicentre retrospective hospital registry study

Background: We investigated the effects of ketamine on desaturation and the risk of nursing home discharge in patients undergoing procedural sedation by anaesthetists. Methods: We included adult patients who underwent procedures under monitored anaesthetic care between 2005 and 2021 at two academic healthcare networks in the USA. The primary outcome was intraprocedural oxygen desaturation, defined as oxygen saturation <90% for ≥2 consecutive minutes. The co-primary outcome was a nursing home discharge. Results: Among 234,170 included patients undergoing procedural sedation, intraprocedural desaturation occurred in 5.6% of patients who received ketamine vs 5.2% of patients who did not receive ketamine (adjusted odds ratio [OR_adj] 1.22, 95% confidence interval [CI] 1.15–1.29, P<0.001; adjusted absolute risk difference [ARD_adj] 1%, 95% CI 0.7–1.3%, P<0.001). The effect was magnified by age >65 yr, smoking, or preprocedural ICU admission (P-for-interaction <0.001, OR_adj 1.35, 95% CI 1.25–1.45, P<0.001; ARD_adj 2%, 95% CI 1.56–2.49%, P<0.001), procedural risk factors (upper endoscopy of longer than 2 h; P-for-interaction <0.001, OR_adj 2.91, 95% CI 1.85–4.58, P<0.001; ARD_adj 16.2%, 95% CI 9.8–22.5%, P<0.001), and high ketamine dose (P-for-trend <0.001, OR_adj 1.61, 95% CI, 1.43–1.81 for ketamine >0.5 mg kg⁻¹). Concomitant opioid administration mitigated the risk (P-for-interaction <0.001). Ketamine was associated with higher odds of nursing home discharge (OR_adj 1.11, 95% CI 1.02–1.21, P=0.012; ARD_adj 0.25%, 95% CI 0.05–0.46%, P=0.014). Conclusions: Ketamine use for procedural sedation was associated with an increased risk of oxygen desaturation and discharge to a nursing home. The effect was dose-dependent and magnified in subgroups of vulnerable patients.