Which sedative would be most appropriate in treating a combative head injury patient?

Thank you for your question. Both ketamine and midazolam are ideal agents for agitation secondary to a head injury due to their short time of onset and relatively short half time. They have made the job of agitation management easier. In most cases, the decision is based upon the patient’s clinical condition i.e. GCS, airway, degree of agitation, and physician preference. Ketamine is preferred over midazolam because we do not have to worry about the possibility of respiratory depression with escalating doses and we achieve quicker sedation at lower doses than we do with midazolam. The issue with ketamine in the past was the unfounded allegation that it increased ICP and therefore was contraindicated in head injury patients. This has since been disproven thereby giving us another useful agent in the treatment of head injured patients. In summary, both agents are acceptable for the treatment of agitation secondary to a head injury.