Ketamine

• Ketamine

• Ketalar

Classification:

• Dissociative anesthetic with profound analgesic and moderate hypnotic properties 

Mechanism of Action:

• N-methyl-D-aspartate (NMDA) – receptor antagonist
• Sympathomimetic properties, inhibition of central/peripheral cholinergic transmission with effects on opiate receptors
• Onset intravenous/intraosseous 1-2 minutes with a duration of 5-10 minutes; intranasal 5-10 minutes with a duration up to 60 minutes

Indications:

• Induction and maintenance of general anesthesia
• Analgesia and sedation
• Rapid Sequence Sedation/Drug assisted intubation 

Contraindications:

• Hypersensitivity
• Increased ICP
• Seizure disorders
• Uncontrolled HTN

Adverse Effects:

• Increased oral secretions
• Tachy/brady arrhythmias
• Increased ICP
• Mild cardiac depression
• Nystagmus
• Transient laryngospasm
• Hallucinations

Dose:

• Analgesia
  • 0.15 mg/kg IV/IO/IN; may be repeated every 5-10 minutes to a maximum of 2 doses
  • Preference is IV/IO first; if unable to obtain access, can then be given IN
• Procedural sedation (non-intubated):
  • Initial: 0.5-1 mg/kg IV/IO over 2 minutes
  • Repeat boluses: 0.25 – 0.5 mg/kg IV/IO; can be repeated every 15 minutes to a maximum of 2 doses
• Drug Assisted Intubation:
  • 2 mg/kg IV/IO
  • 1 mg/kg IV/IO for patients in shock
• Post-intubation Sedation (Advanced Airway):
  • 0.5 mg/kg IV/IO
  • 0.5 mg/kg/hr OR 8 mcg/kg/min IV/IO (200 mg in 100 mL of solution) infusion to a maximum infusion rate of 1.8 mg/kg/hr OR 30 mcg/kg/min
• Chemical Restraint
  • Agitation dosage:
    • 0.5 mg – 1.0 mg/kg IV/IO single dose after midazolam has been maxed
  • Excited Delirium dosages:
    • 4 mg/kg IM (max dosage 4 mg/kg)

• Same as adult dosage (infusion dosage 8 mcg/kg/min – 30 mcg/kg/min)
• Post- intubation sedation for an advanced airway is for patients greater than 5 kg

• IV, IO, IN

• Compatible with D5W or NS
• Compatible at Y site with (partial list): Propofol, Fentanyl, Midazolam, Morphine, Lidocaine, Hydromorphone)

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2^nd Edition