Page 137 - Journal of Special Operations Medicine - Spring 2017

Appendix C Ketamine-Drip Dosing Tables
Ketamine drip (for sedation): Sedation loading dose first (1mg/kg IV/IO over 60 seconds).
MIX: 750mg (1.5 vials of 500mg/5mL) in 250mL of normal saline (3mg/mL solution).
Initial drip dose:
• Best: Using an IV pump, set to μg/kg/min dose desired. Increase or decrease dose by 5–10μg/kg/min increments.
• Better: Using a dial flow adaptor, initial drip rate in mL/h equals the casualty’s weight in kg divided by 2
(see table).
• Minimum: Count drip rate. Increase or decrease rate by 1–2 drips/min (very slowly) to achieve goal.
Drip adjustments:
• Increase or decrease drip by 0.25mg/kg/h (1 row).
Ketamine drip rate for dial flow or IV pump (starting dose highlighted)
Patient’s Weight, kg
Dose 40 60 80 100
mg/kg/h μg/kg/min Infusion Rate, mL/h
0.5 8 7* 10 13 17
0.75 13 10 15 20 25
1.0 17 13 20 27 33
1.25 21 17 25 34 42
1.5 25 20 30 40 50
1.75 29 24 35 47 59
2.0 33 27 40 53 67
Ketamine drip count for 15 drips/mL tubing (starting dose highlighted)
Infusion Rate, 1 drip/X seconds
0.5 8 1/35 1/24 1/18 1/9
0.75 13 1/27 1/18 1/14 1/8
1.0 17 1/18 1/12 1/9 1/7
1.25 21 1/15 1/10 1/8 1/6
1.5 25 1/12 1/8 1/6 1/5
1.75 29 1/11 1/7 1/6 1/5
2.0 33 1/9 1/6 1/5 1/4
Ketamine drip count for 10 drips/mL tubing (starting dose highlighted)
Infusion Rate, 1 drip/X seconds
0.5 8 1/53 1/36 1/27 1/14
0.75 13 1/41 1/27 1/21 1/12
1.0 17 1/27 1/18 1/14 1/11
1.25 21 1/23 1/15 1/12 1/9
1.5 25 1/18 1/12 1/9 1/8
1.75 29 1/17 1/11 1/9 1/8
2.0 33 1/14 1/9 1/8 1/6
Procedural Sedation
Step 1: Bolus (1.0–2.0mg/kg) 80–160mg ketamine IV/IO over 60 seconds (250–400mg IM if necessary).
Step 2: Consider adding (start low, give more):
• 25–100μg fentanyl IV/IO
• 1–4mg midazolam IV/IO
Step 3: May need to repeat doses as below if procedure lasts longer than 10–15 minutes.
• Ketamine every 10–15 minutes
• Fentanyl every 15–30 minutes
• Midazolam every 30–60 minutes
*dial flow adaptor not accurate for rate < 10mL/h; use drip count

Guidelines: Analgesia and Sedation During PFC 113