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