Page 134 - 2026 SMOG

KETAMINE (KETALAR)
Class/Mechanism of Action
• Antidepressant; General Anesthetic
Dissociative anesthetic; produces a cataleptic-like state acting directly on the cortex and limbic system.
˚ Onset of action—IV: 30–60sec; Duration: dose dependent averaging 10–20min
Indications
• Labeled Indications
Induction and maintenance of general anesthesia
• ˚ Off-Label Indications
Analgesia and sedation
˚ ˚ Preferred general anesthetic/sedative (pre-hospital) for head injury patients (does not raise ICP)
Contraindications
• Hypersensitivity to ketamine or any component of the formulation
• Conditions that cannot tolerate sustained increases in blood pressure (non-traumatic intracerebral
hemorrhage, hypertension associated with acute coronary syndrome; NOT contraindicated in TBI)
• Children <3 months in age
Adverse Reactions/Precautions
• Rapid IV administration may cause hypotension, apnea, or laryngospasm. Large doses (>1mg/kg) may
cause hypotension and respiratory depression.
• Use with caution in patients with cardiovascular disease. Continuously monitor cardiac function.
• Dosing between 0.5–0.9mg/kg IV (and equivalent IM dose) can give patients the feeling of unreality,
leading to agitation, and should be avoided.
• If the patient experiences Ketamine Induced Agitation (Emergence Phenomena), give Midazolam
• 2–5mg IV one time for adults and 0.05mg/kg for children who are not hypotensive or in danger of being
hypotensive
• Pregnancy: Low doses of ketamine may be used, but other agents are preferred.
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
LOW DOSE Analgesia/Sedation
Analgesia • IV
• IV/IO Push over 1min 0.1–0.3mg/kg, slow IV push or infusion over
0.1–0.3mg/kg, q10–30min prn ˚ 10–15min
• ˚ IM/IN • IN (children >6 years old)
˚ 0.5–1.0mg/kg, q10–30min prn ˚ 0.5–1mg/kg, may repeat 0.25mg/kg in 10min
HIGH DOSE Induction of anesthesia
RSI/Induction of Anesthesia; Combative Patients • IV 1–2mg/kg
˚
• IV (SLOW) Maintenance of anesthesia
1–2mg/kg
• ˚ IM • IV Continuous Infusion (infants ≥5 months,
children, and adolescents)
˚ 4–5mg/kg 0.5–2mg/kg IV, then 5–20mcg/kg/min IV
Maintenance of anesthesia ˚ infusion, starting at the lowest dose and
• IV titrating upward prn
0.5–2mg/kg q10–20min Note: Avoid sub-dissociative doses to prevent an
• ˚ IV Continuous Infusion emergence phenomenon
0.5–2mg/kg bolus, then 1–3mg/kg/hr.
˚ Titrate levels by 0.25mg/kg/hr as needed to Note: If the patient experiences Ketamine Induced
achieve appropriate sedation (See infusion Agitation (Emergence Phenomena), give Midazolam
2–5mg IV one time for adults and 0.05mg/kg for
chart next page)
children who are not hypotensive or in danger of
being hypotensive
126 • MEDICATIONS