Page 149 - 2023 SMOG Digital

KETAMINE C, Lactation Yes (Risk not ruled out) Trade Name: Ketalar
Class / Mechanism of Action
General Anesthetic
Dissociative anesthetic; produces a cataleptic like state acting directly on the cortex and limbic system.
Onset of action IV: 30-60 seconds; Duration is dose dependent averaging 10-20 minutes
Indications
Labeled Indications: Induction and maintenance of general anesthesia
Unlabeled: Analgesia and sedation
Contraindications
• Hypersensitivity to ketamine or any component of the formulation
• Conditions that cannot tolerate increases in blood pressure
o E.g. spontaneous cerebral hemorrhage or acute coronary syndrome hypertension
• Children <3 mo age
Adverse Reactions / Precautions
• Rapid IV administration may cause hypotension, apnea, or laryngospasm. Large doses may cause
hypotension and respiratory depression
• Use with caution in patients with cardiovascular disease. Continuously monitor cardiac function.
• Preferred general anesthetic/sedative for hypo/normotensive head injury patient.
• 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.
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
LOW DOSE: Analgesia:
Analgesia: IM:
IV/IO Push (over 1 min) • • IV: 0.5mg/kg, q10-30min prn
• • 0.1-0.2mg/kg, repeat q10-30min prn • • 0.1–0.2mg/kg, q10-30min prn
IM/IN
• • 0.5 mg/kg, repeat q10-30min prn Induction of anesthesia (unlabeled dosing):
IV:
HIGH DOSE: • • 1-2mg/kg (3-5mg/kg for procedural
sedation)
RSI / Induction of anesthesia; Combative
Patients: Maintenance of anesthesia:
IV Push IV :
• • 1-2mg/kg • ½ to Full induction dose every 20-30 minutes
IM IV Continuous Infusion:
• • 4-5mg/kg • 0.5-1mg/kg/hr. Titrate levels by 0.25mg/kg/hr
Maintenance of anesthesia: prn to achieve appropriate sedation.
IV :
• • 0.5-2mg/kg dose q10-20min
IV Continuous Infusion
• • 0.5-2mg/kg bolus then 0.5-1mg/kg/hr. Titrate **NOTE** Avoid sub-dissociative doses to prevent
levels by 0.25mg/kg/hr prn to achieve emergence phenomenon.
appropriate sedation. (See infusion chart next
page)
NOTE: If patient experiences Ketamine Induced Agitation (Emergence Phenomena) give Midazolam 2-
5mg IV x1 for adults and 0.05 mg/kg for children not hypotensive or in danger of being hypotensive.
l l f h d h dd l /k

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