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Ketamin

Adult dosing:

Procedural sedation
  • 1 to 2 mg/kg IV over 1 to 2 minutes, may be followed by 0.25 to 0.5 mg/kg IV every 5 to 10 minutes as needed (study dosage) [2]
Rapid sequence intubation, Induction

Pediatric dosing:

Pain, acute (Moderate to Severe)
  • (3 to 13 years, less than 50 kg) 1 mg/kg intranasally via nasal atomizer device (study dosage) [6]
Procedural sedation
  • 0.5 to 2 mg/kg IV over 1 to 2 minutes, may repeat 0.25 to 1 mg/kg IV (one-half initial dose) every 10 to 15 minutes as needed (study dosage) [7][8][9][10]
  • 2 to 5 mg/kg IM, may repeat 2 to 4 mg/kg after 10 minutes (study dosage) [7][8][9][10][11]
  • (1 year or older) 5 mg/kg intranasally 30 minutes before IV cannulation (study dosage) [12]
Rapid sequence intubation, Induction

Dose Adjustments:

liver disease: dose reductions with hepatic impairment due to prolonged duration of action

Administration:

Intravenous
  • dilute the 100 mg/mL product prior to administration; do not further dilute the 10 mg/mL product [15]
  • (bolus) dilute 100 mg/mL product with an equal volume of sterile water for injection, NS, or D5W prior to injection [15]
  • (bolus) administer slowly over at least 60 seconds or at 0.5 mg/kg/min for anesthesia induction [15]
  • (infusion) dilute product to infusion concentration of 1 to 2 mg/mL, depending on patient factors [15]
  • (infusion) may be administered by slow infusion of 0.1 to 0.5 mg/min for anesthesia maintenance [15]

Contraindications:

 

  • conditions where significant elevations in blood pressure would be a serious hazard [16]
  • hypersensitivity to ketamine or any other product component [16]

Precautions:

 

  • 100 mg/mL concentration; not to be injected IV without proper dilution in equal volume of sterile water for injection, NS, or D5W [16]
  • alcohol intoxication or history of alcohol abuse [16]
  • cerebrospinal fluid pressure, elevated (preanesthetic); increase in cerebrospinal fluid pressure has been reported [16]
  • hypertension or cardiac decompensation; monitoring is recommended [16]
  • mechanical stimulation of the pharynx; avoid when ketamine used as monotherapy [16]
  • postoperative confusional state may occur; minimize verbal, tactile and visual stimulation during recovery [16]
  • rapid rate of administration or overdose; increased risk of respiratory depression, apnea, and enhanced pressor response [16]
  • vomiting may occur; risk of aspiration [16]

Adverse Effects:

Common
  • Cardiovascular: Hypertension, Tachycardia
  • Neurologic: Emergence from anesthesia, Psychiatric sign or symptom (12% to 50% )
Serious
  • Cardiovascular: Bradyarrhythmia, Cardiac dysrhythmia, Hypotension
  • Immunologic: Anaphylaxis
  • Respiratory: Apnea, Laryngeal spasm, Pulmonary edema, Respiratory depression

Pregnancy / Lactation:

Pregnancy Category

 

 

Breast Feeding

 

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