ADMINISTRATION ROUTES:
IV
ALTERNATIVE NAMES:
Ketalar
ICU INDICATIONS:
- Analgesia
- Induction of anaesthesia
PRESENTATION AND ADMINISTRATION:
IV:
200 mg/2 mL vial
Compatible with the following IV fluids:
Normal saline, 5% dextrose
Store at room temperature.
For infusion dilute with compatible IV fluid to a dilution of 1 mg/mL (e.g. 50 mg in 50 mL)
DOSAGE:
IV:
Induction of anaesthesia:
100 - 200 mg IV
Analgesia:
Dilute to 1 mg/mL
Administer bolus doses 1 - 2 mg (1 - 2 mL)
Infusion 1 - 10 mg/hr if required
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
DOSAGE IN PAEDIATRICS:
Induction of anaesthesia:
1-2 mg/kg IV
Analgesia:
0-4 mcg/kg/min
CLINICAL PHARMACOLOGY:
Ketamine is a rapid-acting general anaesthetic producing an anaesthetic state characterised by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression.
CONTRAINDICATIONS:
- Any condition where severe hypertension would constitute a serious hazard
WARNINGS:
Emergence reactions have occurred in approximately 12% of patients. The psychological manifestations vary in severity between pleasant dream-like states, vivid imagery, hallucinations, and emergence delirium. In some cases these states have been accompanied by confusion, excitement, and irrational behaviour which a few patients recall as an unpleasant experience. The duration ordinarily is no more than a few hours. In a few cases, however, recurrences have taken place up to 24 hours postoperatively. The incidence of these emergence phenomena is least in the young (15 years of age or less) and elderly (over 65 years of age) patient.
PRECAUTIONS:
General:
An increase in intracranial pressure has been reported following administration of ketamine. Use with extreme caution in patients with raised intracranial pressure.
Laboratory Tests:
No tests in addition to routine ICU tests are required.
Drug/Laboratory Test Interactions:
None noted.
IMPORTANT DRUG INTERACTIONS IN ICU:
None of note
ADVERSE REACTIONS:
General:
Anaphylaxis. Local pain and exanthema at the injection site have infrequently been reported. Transient erythema and/or morbilliform rash have also been reported
Cardiovascular:
Blood pressure and pulse rate are frequently elevated following administration of ketamine. However, hypotension and bradycardia have been observed. Arrhythmia has also occurred
Respiratory:
Although respiration is frequently stimulated, severe depression of respiration or apnea may occur following rapid intravenous administration of high doses of ketamine. Laryngospasms and other forms of airway obstruction have occurred during ketamine anaesthesia
Neurological:
In some patients, enhanced skeletal muscle tone may be manifested by tonic and clonic movements sometimes resembling seizures
Gastrointestinal:
Anorexia, nausea and vomiting have been observed; however this is not usually severe