NATIONAL
CALIFORNIA
VENTURA
mechanism
  • Produces a state in which the patient is dissociated from the surrounding environment by direct action on the cortex and limbic system. Ketamine is a noncompetitive NMDA receptor antagonist that blocks glutamate.
indications
  • Rapid sequence intubation
contraindications
  • Conditions in which an increase in blood pressure would be hazardous
dosing

Adults

Note: Consider in patients with bronchospasm and/or hemodynamic compromise

IV: Initial: 1 to 2 mg/kg once over 1 minute; in patients with shock, use 1 mg/kg

Intraosseous (use only if IV access is not available): Initial: 100 mg once.

Pediatric

IV: 1 to 2 mg/kg as part of rapid sequence sedation

administration
IV: administer bolus/induction doses over 1 minute or at a rate of 0.5 mg/kg/minute; more rapid administration may result in respiratory depression and increased hypertensive response
onset

IV: Anesthetic effect: Within 30 seconds

duration

IV: Anesthetic effect: 5 to 10 minutes; Recovery: 1 to 2 hours

notes
  • Airway complications: When used for sedation for procedures involving the posterior pharynx or in patients with an active pulmonary infection or disease (including upper respiratory disease or asthma), the use of ketamine increases the risk of laryngospasm (rare and typically transient).
  • Cardiovascular effects: Ketamine causes increased blood pressure, increased heart rate, and increased cardiac output, thereby increasing myocardial oxygen demand; cardiac arrhythmia, cardiac decompensation, decreased blood pressure, and decreased heart rate have also been reported. Resolution of increased blood pressure usually occurs within 15 minutes after the peak.
  • Emergence reactions: Prolonged emergence from anesthesia, which can manifest as vivid dreams, hallucinations, and/or frank delirium commonly occur in all ages.
  • Respiratory depression: Ketamine may rarely cause respiratory depression or apnea, which are usually transient. These adverse reactions are most associated with rapid IV administration.
dosage form
Solution, Injection:10 mg/mL (20 mL); 50 mg/mL (10 mL); 100 mg/mL (5 mL, 10 mL)
brand name
Ketalar
adverse reactions
  • Cardiovascular
    • Cardiac arrhythmia
    • Cardiac decompensation
    • Decreased blood pressure
    • Decreased heart rate
    • Increased blood pressure
    • Increased heart rate
  • Gastrointestinal
    • Anorexia
    • Nausea
    • Vomiting
  • Nervous system
    • Prolonged emergence from anesthesia (includes agitation, confusion, delirium, dreamlike state, excitement, hallucinations, irrational behavior, vivid imagery)
    • Hypertonia (tonic-clonic movements sometimes resembling seizures)
    • Psychiatric disturbance
  • Ophthalmic
    • Diplopia
    • Increased intraocular pressure
    • Nystagmus
  • Respiratory
    • Airway obstruction
    • Apnea
structure
ketamine.svg molecular structure