Ketamine: Difference between revisions
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==General== | ==General== | ||
*Type: | *Type: Dissociative anesthetic | ||
*Dosage Forms: | *Dosage Forms: 10, 50, 100 mg/ml IV, IM | ||
*Common Trade Names: | *Common Trade Names: Ketalar | ||
==Adult Dosing== | ==Adult Dosing== | ||
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==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B | ||
*[[Lactation risk categories|Lactation risk]]: | *[[Lactation risk categories|Lactation risk]]: | ||
*Renal Dosing | *Renal Dosing | ||
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==Pharmacology== | ==Pharmacology== | ||
*Half-life: | *Half-life: 2.5 hours | ||
*Metabolism: | *Metabolism: Hepatic | ||
*Excretion: | *Excretion: Urine | ||
*Mechanism of Action: | *Mechanism of Action: Excact mechanism unknown | ||
==Comments== | ==Comments== | ||
Revision as of 01:18, 6 July 2015
General
- Type: Dissociative anesthetic
- Dosage Forms: 10, 50, 100 mg/ml IV, IM
- Common Trade Names: Ketalar
Adult Dosing
Procedural Sedation or Induction
- 1 mg/kg IV, followed by 0.5-1 mg/kg IV PRN
or
- 4-5 mg/kg IM → repeat 2-4 mg/kg IM after 10 min if first dose unsuccessful
Analgesia
- 0.1-0.5 mg/kg IV PRN[1]
Pediatric Dosing
Procedural Sedation or Induction
- 1.5-2 mg/kg IV
or
- 4-5 mg/kg IM[2]
or
- 3-6 mg/kg IN[3]
Special Populations
- Pregnancy Rating: B
- Lactation risk:
- Renal Dosing
- Adult
- Pediatric
- Hepatic Dosing
- Adult
- Pediatric
Contraindications
- Allergy to class/drug
Absolute
- <3 month old
- Known or suspected schizophrenia, even if currently stable or controlled with medications
Relative
- Major procedures involving posterior pharynx (e.g. endoscopy)
- Typical minor ED oropharyngeal procedures are okay
- Airway instability (e.g. tracheal stenosis, tracheal surgery)
- Active pulmonary infection, including URI or asthma (unless for induction)
- CAD, HTN, CHF
- CNS masses, hydrocephalus (head trauma okay)
- Glaucoma/acute globe injury
- Thyroid disorder or on thyroid medication
Adverse Reactions
- Laryngospasm (0.3%)
- Only associated with unusually high IV doses
- Tx = BVM ventilation; intubation is rarely needed
- Apnea or respiratory depression (0.8%)
- Associated with rapid IV push
- Transient
- Hypersalivation (rare)
- Emesis, usually well into recovery (8.4%)
- Recovery agitation, aka emergence reaction (mild in 6.3%, clinically important in 1.4%)
- Muscular hypertonicity and random, purposeless movements (common)
- Clonus, hiccuping, or short-lived nonallergic rash of face and neck
Intracranial pressure elevation
- Cerebral perfusion pressure (CPP) was compromised only in the patients with pre-existing intracranial hypertension and obstruction to the flow of cerebral spinal fluid. This has, however, led to the persistent belief that ketamine is contraindicated in patients with traumatic head injuries. Studies done subsequently have shown, however, that the effects of ketamine on cerebral haemodynamics and ICP are in fact variable and depend on both the presence of additional anaesthetic agents and PaCO2 values.[4] Meta-analysis also suggests that Ketamine does not increase ICP and provides favorable hemodynamics.[5]
Neurologic Injury
- Metaanalysis has shown that when ketamine is used in the presence of controlled ventilation, in conjunction with anaesthetics which reduce cerebral metabolism such as GABA receptor agonists, ICP is not increased.[6]
Serious
Common
Pharmacology
- Half-life: 2.5 hours
- Metabolism: Hepatic
- Excretion: Urine
- Mechanism of Action: Excact mechanism unknown
Comments
- Given as a slow push bolus.
- Rapid bolus increases risk for apnea.
- IV preferred over IM (faster recovery, less emesis)
- Nystagmus is seen as an effect of the medication
See Also
References
- ↑ Morton NS. Ketamine for procedural sedation and analgesia in pediatric emergency medicine: a UK perspective. Paediatr Anaesth. 2008;18:25-29
- ↑ Green S. et al. What is the optimal dose of intramuscular ketamine for pediatric sedation?. Acad Emerg Med. 1999 Jan;6(1):21-6
- ↑ Hall, D, et al. Intranasal ketamine for procedural sedation. Emerg Med J. 2014; 31:789-90.
- ↑ Filanovsky, Y., Philip Miller et al. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. CJEM 2010;12(2):154-7. PDF
- ↑ Wang X et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth 2014. PubMed ID: 24859931
- ↑ Himmelseher S. et al. Revising a dogma: ketamine for patients with neurological injury? Anesth Analg. 2005 Aug;101(2):524-34 PDF