Comparative Evaluation of Ketamine and Dexmedetomidine for Procedural Sedation in Emergency Settings: Sedation Efficacy, Hemodynamic Stability, Recovery Time and Adverse Events

Open Access

Abstract

Background: Procedural sedation and analgesia (PSA) are essential in emergency medicine. Ketamine provides rapid dissociative sedation and analgesia with relative preservation of airway reflexes, whereas dexmedetomidine produces cooperative sedation with minimal respiratory depression but may cause bradycardia and hypotension. Objective: To compare ketamine and dexmedetomidine regarding sedation quality, hemodynamic stability, recovery, procedural success, satisfaction and adverse events during emergency procedural sedation. Methods & Materials: This prospective comparative observational study was conducted in the Department of Anaesthesia, Chittagong Medical College Hospital, Chattogram, Bangladesh, from January to December 2025. One hundred adults requiring procedural sedation were enrolled consecutively; 50 received intravenous ketamine and 50 received intravenous dexmedetomidine according to institutional protocols. Sedation quality was assessed using the Ramsay Sedation Scale. Hemodynamic parameters, onset of sedation, procedure initiation time, recovery time, procedural success, satisfaction and adverse events were recorded. Results: Baseline characteristics were comparable. Ketamine produced significantly faster sedation onset and shorter procedure initiation time (p<0.001). Recovery was also faster with ketamine (18.4±4.6 vs. 27.1±5.8 minutes; p<0.001). Dexmedetomidine provided significantly greater hemodynamic stability (p<0.05). Hypertension and emergence reactions were more frequent with ketamine, whereas bradycardia and hypotension occurred more often with dexmedetomidine. Respiratory complications were uncommon and procedural success exceeded 95% in both groups. Conclusion: Both agents were effective and generally safe. Ketamine offered faster onset and recovery, whereas dexmedetomidine provided superior hemodynamic stability. Sedative selection should be individualized according to patient and procedural factors.