Adult Dosing

Anesthesia induction

• IV route
• 1-4.5 mg/kg over 1 min
• Alt: 1-2 mg/kg at a rate of 0.5 mg/kg/min with IV diazepam 2-5 mg
• Onset; 30 seconds; duration: 5-10 mins, for 2 mg/kg dose

• IM route
• 6.5-13 mg/kg
• Onset; 3-4 mins; duration: 12-25 mins, for 10 mg/kg dose

Anesthesia maintenance

• 0.5-4.5 mg/kg IV over 1 min
• Alt: 0.1-0.5 mg/min IV PRN with IV diazepam 2-5 mg
• Alt: 3.25-13 mg/kg IM PRN

Note:

• The 100 mg/mL concentration should not be injected intravenously without proper dilution. It is recommended the drug be diluted with an equal volume of either Sterile Water for injection, USP, Normal Saline, or 5% Dextrose in Water.

Pediatric Dosing

• Safety and effectiveness in pediatric patients <16 yrs have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Anesthesia for short term diagnostic and surgical procedures that do not require skeletal muscle relaxation
• As induction prior to the administration of other general anesthetic agents
• As a supplement to other low-potency anesthetics agents

• Hypersensitivity to any of the ingredients of the product
• Condition in which blood pressure elevation is hazardous

• Emergence reactions varying in severity between pleasant dream like states, vivid imagery, hallucination and emergence delirium accompanied by confusion, excitement and irrational behavior have been reported in 12% of patients which last no more than few hours, recurrence was reported 24 hr postoperatively in few cases. No residual phychological effect seen
• The incidence of emergence reaction is least in elderly and less frequent when given IM or as experience with the drug is gained
• The Emergence reactions may be reduced by using lower recommended dose of ketamine in combination with intravenous diazepam during induction and maintenance of anesthesia and also by minimizing verbal, tactile and visual stimulation of the patients during recovery period
• Severe emergence reaction can be terminated by use of small hypnotic dose of short acting or ultra short acting barbiturate. When used on an outpatient, patient should not be released until recovery from anesthesia is complete and should be accompanied by a responsible adult

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment : Caution advised. Specific dose adjustments not defined

• Continually monitor cardiac function during the procedure in patients found to have hypertension or cardiac decompensation
• Postoperative emergence reaction can occur during recovery period [US Black Box Warnings]
• Overdosage or too rapid administration of ketamine causes respiratory depression, provide supportive ventilation
• Ketamine should be administered under the direction of experienced physician and in maintenance of airway and respiration
• Vomiting may occur, therefore a risk of aspiration
• Do not use ketamine alone in surgery or diagnostic procedures of the pharynx, larynx, or bronchial tree as pharyngeal and laryngeal reflexes are usually active. When used alone avoid mechanical stimulation. Use muscle relaxant with proper attention to respiration and resuscitative equipment should be readily available
• Surgical procedures involving visceral pain pathways, Ketalar should be supplemented with an agent which obtunds visceral pain
• Ketamine administration causes increase in cerebrospinal fluid pressure, use cautiously in preanesthetic elevated cerebrospinal fluid pressure

Cautions: Use cautiously in

• Hepatic dysfunction
• Chronic alcoholic or acutely alcohol-intoxicated patient
• Increased Intra Cranial Pressure
• Hypertension or cardiac decompensation
• Increased Intra Ocular Pressure

Pregnancy Category:B

Breastfeeding: Safety not established. Use not recommended

• CV: Hypertension, tachycardia, hypotension, bradycardia, arrhythmia
• RESP: Apnea, laryngospasms, respiratory depression
• EENT: Diplopia, nystagmus, increase in IOP
• PSYCHIATRIC: Dream like state, vivid imagery, hallucination, confusion, excitement, irrational behavior
• CNS: Increase intracranial pressure
• GI: Anorexia, nausea, vomiting
• MUSC: Tonic clonic movements
• LOCAL: Pin, rash, exanthema, erythema
• MISC: Anaphylaxis

• Anesthetic agent; interrupt association pathways of the brain before producing somesthetic sensory blockade, selectively depress the thalamoneocortical system before significantly obtunding the more ancient cerebral centers and pathways
• Rapidly absorbed following parenteral administration
• Metabolism: liver by N-demethylation and hydroxylation of cyclohexone ring
• Primarily renally excreted; feces (3%)
• Half life: 2.5 hrs

US Trade Name(s)

• Ketalar

US Availability

ketamine hydrochloride (generic)

• INJ: 10 mg/mL (20 mL vial)
• INJ: 50 mg/mL (10 mL vial)
• INJ: 100 mg/mL (10 mL vial)

Ketalar

• INJ: 10 mg/mL (20 mL vial)
• INJ: 50 mg/mL (10 mL vial)
• INJ: 100 mg/mL (5 mL vial)

Canadian Trade Name(s)

• Ketalar

Canadian Availability

ketamine hydrochloride (generic)

• INJ: 10 mg/mL
• INJ: 50 mg/mL

Ketalar

• INJ: 10 mg/mL (20 mL vial)
• INJ: 50 mg/mL (10 mL vial)

UK Trade Name(s)

• Ketalar

UK Availability

Ketalar

• INJ: 10 mg/mL (20 mL vial)
• INJ: 50 mg/mL (10 mL vial)
• INJ: 100 mg/mL (10 mL vial)

Australian Trade Name(s)

• Ketalar

Australian Availability

Ketalar

• INJ: 100 mg/mL (2 mL vial)

[Outline]

Anesthesia

General Anesthetics