Critical Care Trauma Centre

KETAMINE (Ketalar)

 

Name: KETAMINE (KetalarR)
Classification: cataleptic, analgesic and anesthetic agent
  • produces an anesthetic state characterized by profound analgesia, but without any sedation, hypnosis or effect on pharyngeal laryngeal reflexes
  • reduces lower airway resistance and increases lung compliance in patients with bronchospasm
  • has been used as adjunct to difficult or painful examinations and procedures
Dose:
  • for induction of anesthesia:
    • 1.0-2.0 mg/kg IV bolus over 1-2 minutes, or 4-8 mg/kg IM; 50% of induction dose repeated as necessary for maintenance of anesthesia (q5-30 min)
  • for treatment of bronchospasm:
    • 1.0-2.0 mg/kg induction followed by 0.1-0.5 mg/min maintenance infusion
  • for sedation and analgesia during procedures:
    •  0.2 to 1.0 milligram/kilogram over 2 to 3 minutes, followed by continuous infusion of 5 to 20 micrograms/kilogram/minute or repeated as required
Administration:

Continuous I V Infusion:
500 mg in 50 ml dextrose 5% or sodium chloride 0.9%

Intermittent IV Infusion:
Dilute in dextrose 5% or sodium chloride 0.9% to a maximum concentration 5 mg/ml.

Adverse Effects:
  • purposeless movements of extremities (not indicative of level of anesthesia)
  • increased BP
  • increased HR
  • vivid dreams, with confusion or hallucinations, particularly during emergence from anesthesia; can be decreased with diazepam or decreasing sensory load
  • increased salivation; can be decreased with atropine or scopolamine
  • respiratory depression, mainly with too rapid administration
  • increased cerebral spinal fluid pressure
  • nausea/vomiting
  • increased intraocular pressure
Drug Interactions:
  • ketamine + barbiturates = prolonged recovery time from ketamine
  • ketamine + narcotics = prolonged recovery time from ketamine
  • ketamine + atracurium = increased neuromuscular blockade
  • ketamine + theophylline = possible decrease in seizure threshold
Monitoring Therapy:
  • blood pressure
  • heart rate
  • respiratory rate
  • oxygen saturation; blood gases
  • skeletal muscle tone
  • presence of emergence reactions
  • level of consciousness
  • adequacy of pain control
Adult Critical care Protocol:
  • May be administed IV direct or by IV infusion by a nurse in Adult Critical Care
  • Continuous infusions must be administered by infusion device with pump library enabled.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 20, 2018