Ketamine (Ketalar)

Category:

  • General anesthetic

Description:

  • Intravenous anesthetic

Indications:

  • General anesthesia

  • Sedation induction (non-FDA approved)

Contraindications:

  • Intracranial bleeding, intracranial mass

  • Myocardial infarction

Precautions:

  • Pregnancy category C

  • Concomitant hypertensive agents, thyroid hormones

  • Tachycardia

  • Concomitant CNS depressant agents

Adverse Reactions (Side Effects):

  • CNS: CNS depression, delirium, hallucinations, nightmares

  • CV: hypertension/hypotension, sinus bradycardia, sinus tachycardia

  • GI: anorexia, nausea, vomiting

  • EENT: diplopia, laryngospasm

  • MISC: macropapular rash, nystagmus

Dosage:

Administered intravenously, intramuscularly

  • General anesthesia induction (IV): 

    • Adult: 

      • IV 1-4.5 mg/kg slowly over 60 seconds: 

      • 2 mg/kg will produce 5-10 minutes of surgical anesthesia

    • Child: 

      • IV 0.5-2 mg/kg

      • Do not exceed 0.5 mg/kg/min or administer dose faster than 60 seconds

      • Usual induction 1-2 mg/kg to produce 5-10 minutes of surgical anesthesia

  • General anesthesia induction (IM): 

    • Adult: 

      • IM 6.5-13 mg/kg: 

      • 10 mg/kg generally produces 12-25 minutes of surgical anesthesia

    • Child: 

      • IM 3-7 mg/kg will produce 12-25 minutes of surgical anesthesia

  • Maintenance of general anesthesia: 

    • Adult and child: 

      • IV or IM 50%-100% of the full induction dose, repeated as needed

  • Preprocedure sedation induction (minor procedures): 

    • PO (mixed in cola or other beverage) 6-10 mg/kg 

    • IV usual dose 0.5-1 mg/kg (range 0.5-2 mg/kg)

    • Do not exceed 0.5 mg/kg/min or administer faster than over 60 seconds

Special considerations:

  • Administer on empty stomach to prevent vomiting and aspiration

  • Do not mix ketamine and diazepam in same syringe

  • IM: no dilution necessary

  • Direct IV: dilute desired dose of the 100mg/ml concentration with equal parts sterile water for injection, NS, or D5W

  • Continuous IV infusion: dilute to 1mg/kg in 500ml NS or D5W

Drug interactions:

  • Antidepressants

  • Barbiturates

  • Benzodiazepines

  • General anesthetics

  • Local anesthetics

  • Opiates

  • Phenothiazines

  • Skeletal muscle relaxants

  • Thyroid hormones

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