Ketamine is an anesthetic known globally both for its potent dissociative properties and potential for abuse. More recently, ketamine demonstrates utility in a variety of disease states such as treatment-resistant depression, status asthmaticus, and acute agitation. In addition, ketamine has been shown to demonstrate various effects at different doses, which adds to its pharmacological benefit. As these new indications continue to come to light, it is important to stay current with the dosing for these indications as well as the adverse effects associated with ketamine's use. This review highlights the history and mechanism of ketamine as well as addressing the use of the different dosing ranges of ketamine.

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INTRODUCTION/HYPOTHESIS: Modafinil (Provigil®) is an FDA approved tablet to promote wakefulness in patients with narcolepsy, obstructive sleep apnea, and shift work sleep disorder. Delirium has been associated with increased duration of ventilation, hospital length of stay, and mortality in critically ill patients. Current knowledge about modafinil to promote wakefulness and impact delirium in critically ill patients is sparse. The aim of this study was to investigate the impact of modafinil on delirium and associated outcomes in the critically ill population. METHODS:This was a retrospective chart review conducted among Intensive Care Units (ICUs) within an academic medical center. Included patients were at least 18 years old, had an ICU stay for at least 48 hours, and were Confusion Assessment Method for the ICU (CAM-ICU) positive for at least one time during the stay. Exclusion criteria include use of modafinil, benzodiazepine, or antipsychotic use at home, lowest Glasgow Coma Score (GCS) ≥ 13 within 48 hours before study inclusion, history of neurologic impairment, sleep disorders, or psychiatric conditions, and neuroscience admission. Patients receiving modafinil were matched 1:2 to patients without the receipt of modafinil with 54 patients in the modafinil group and 27 control. Patients were matched based on admitting ICU, Sequential Organ Failure Assessment (SOFA) score, and age. The primary outcome of this study was the difference in duration of delirium.