ketamine

Contraindicated in:

Hypersensitivity;
Psychiatric disturbances;
Uncontrolled hypertension;
↑intracranial pressure;
OB: May affect child's brain development when used during 3rd trimester;
Lactation: Lactation.

Use Cautiously in:

Cardiovascular disease;
Procedures involving larynx, pharynx, or bronchial tree (muscle relaxants required);
Gastroesophageal reflux;
Hepatic impairment;
History of alcohol abuse;
Cerebral trauma;
Intracerebral mass or hemorrhage;
Hyperthyroidism;
History of psychiatric problems;
↑intraocular pressure;
Severe eye trauma;
Pedi: Children 3 yr (may affect brain development).

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, tachycardia, arrhythmias, bradycardia, hypotension

Derm: erythema, rash

EENT: diplopia, ↑intraocular pressure, nystagmus

GI: excessive salivation, hepatotoxicity, nausea, vomiting

GU: cystitis

Local: pain at injection site

MS: ↑skeletal muscle tone

Neuro: emergence reactions, ↑intracranial pressure

Resp: laryngospasm, respiratory depression and apnea (rapid IV administration of large doses)

Interactions ⬆ ⬇

Drug-drug:

Use with barbiturates, hydroxyzine and opioid analgesics may result in prolonged recovery time.
Use with halothane may result in ↓ BP, cardiac output, and heart rate.
Use with nondepolarizing neuromuscular blocking agents may result in prolonged respiratory depression.
Concurrent use with levothyroxine↑ risk of tachycardia and hypertension.
Concurrent administration with diazepam may ↓ incidence of emergence reaction.
Concurrent administration with atropine may ↑ incidence of unpleasant dreams.
Concurrent administration with aminophylline or theophylline may ↑ risk of seizures; consider using alternative to ketamine.
Concurrent administration with vasopressin or sympathomimetics may ↑ ketamine's sympathomimetic effects.

Route/Dosage ⬆ ⬇

General Anesthesia

IV (Adults ): Induction: 1–2 mg/kg (range 1–4.5 mg/kg)–2 mg produces 5–10 min of surgical anesthesia or 1–2 mg/kg as a single injection or infused at 0.5 mg/min. May be used with concurrent diazepam. Maintenance: Increments of ½ to the full induction dose may be repeated as needed. If given with concurrent diazepam, an infusion of 0.1–0.5 mg/min may be used, augmented by 2–5 mg doses of diazepam.
IV (Children ): 0.5–2 mg/kg, use smaller doses (0.5–1 mg/kg) for minor procedures.
IM (Adults ): 3–8 mg/kg (10 mg/kg produces 12–25 min of surgical anesthesia).
IM (Children ): 3–7 mg/kg.
PO (Children ): 6–10 mg/kg for 1 dose (mix in cola or other beverage) 30 min prior to procedure.

Sedation/Analgesia (Unlabeled)

IV (Adults ): 200–750 mcg (0.2–0.75 mg)/kg over 2–3 min initially, followed by 5–20 mcg (0.005–0.02 mg)/kg/min as an infusion.
IV (Children ): 5–20 mcg/kg/min.
IM (Adults ): 2–4 mg/kg initially, then 5–20 mcg (0.005–0.02 mg)/kg/min as an IV infusion.

Availability ⬆ ⬇

(Generic available)

Solution for injection (vials and prefilled syringes): 10 mg/mL; 50 mg/mL; 100 mg/mL

Assessment ⬆ ⬇

Assess level of consciousness frequently throughout therapy. Ketamine produces a dissociative state. The patient does not appear to be asleep and experiences a feeling of dissociation from the environment.
Monitor for development of emergence delirium, which may result in confusion or agitation during the recovery period.
Monitor BP, ECG, and respiratory status frequently during therapy. May cause hypertension and tachycardia. May cause ↑ cerebrospinal fluid pressure and increased intraocular pressure.

Lab Test Considerations:

May cause liver dysfunction with recurrent use. Monitor baseline liver function tests (alkaline phosphatase, gamma glutamyl transferase) in patients receiving recurrent doses of ketamine.

Toxicity and Overdose:

Respiratory depression or apnea may be treated with mechanical ventilation.

Implementation ⬆ ⬇

Do not confuse Ketalar with ketorolac. Do not confuse ketamine with ketorolac.
Administer on an empty stomach to prevent vomiting and aspiration.
- May be administered concurrently with a drying agent (atropine, scopolamine); ketamine increases salivary and tracheobronchial mucous gland secretions. Atropine may also increase the incidence of unpleasant dreams.
- Patients may experience a state of confusion (emergence delirium) during recovery from ketamine. Administering a benzodiazepine and minimizing verbal, tactile, and visual stimulation may prevent emergence delirium. Severe emergence delirium may be treated with short- or ultra-short-acting barbiturates.
PO: Use 100 mg/mL IV solution and mix appropriate dose in 0.2–0.3 mL/kg of cola or other beverage.

IV Administration:

Diluent: Dilute 100 mg/mL concentration with equal parts of sterile water for injection, 0.9% NaCl, or D5W. Concentration: Maximum concentration for slow IV push 50 mg/mL.
Rate: Administer over 60 sec unless a rapid-sequence induction technique is indicated. More rapid administration may cause respiratory depression, apnea, and hypertension. Do not exceed 0.5 mg/kg/min.
Diluent: Dilute 10 mL of 50 mg/mL concentration or 5 mL of 100 mg/mL concentration with 500 mL of 0.9% NaCl or D5W and mix well. Concentration: 1 mg/mL. Dilution with 250 mL may be used if fluid restriction is needed, for a maximum concentration of 2 mg/mL.
Rate: Administer at a rate of 0.5 mg/kg/min for induction. Maintenance infusion may be administered at a rate of 1–2 mg/min or 0.1–0.5 mg/min given concurrently with diazepam. Dose must be titrated according to individual patient requirements. Tonic-clonic movements during anesthesia do not indicate the need for more ketamine.

Patient/Family Teaching ⬆ ⬇

Psychomotor impairment may last for 24 hr after anesthesia. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Advise patient to avoid alcohol or other CNS depressants for 24 hr after anesthesia.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected. Ketamine is not recommended for use during pregnancy or delivery.

Evaluation/Desired Outcomes ⬆ ⬇

Sense of dissociation and general anesthesia without muscle relaxation.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0143- West-Ward Pharmaceuticals Corp
- 0143-9508- Ketamine Hydrochloride
  - 0143-9508-10- 10 VIAL in 1 BOX (0143-9508-10) > 10 mL in 1 VIAL (0143-9508-01)

0143- West-Ward Pharmaceuticals Corp
- 0143-9509- Ketamine Hydrochloride
  - 0143-9509-10- 10 VIAL in 1 BOX (0143-9509-10) > 5 mL in 1 VIAL (0143-9509-01)

0409- Hospira, Inc.
- 0409-2051- Ketamine Hydrochloride
  - 0409-2051-05- 10 VIAL, MULTI-DOSE in 1 BOX (0409-2051-05) > 5 mL in 1 VIAL, MULTI-DOSE (0409-2051-15)

0409- Hospira, Inc.
- 0409-2053- Ketamine Hydrochloride
  - 0409-2053-10- 10 VIAL, MULTI-DOSE in 1 BOX (0409-2053-10) > 10 mL in 1 VIAL, MULTI-DOSE (0409-2053-20)

42023- Par Pharmaceutical, Inc.
- 42023-113- Ketalar
  - 42023-113-10- 10 VIAL in 1 CARTON (42023-113-10) > 20 mL in 1 VIAL

42023- Par Pharmaceutical, Inc.
- 42023-114- Ketalar
  - 42023-114-10- 10 VIAL in 1 CARTON (42023-114-10) > 10 mL in 1 VIAL

42023- Par Pharmaceutical, Inc.
- 42023-115- Ketalar
  - 42023-115-10- 10 VIAL in 1 CARTON (42023-115-10) > 5 mL in 1 VIAL

52584- General Injectables and Vaccines, Inc
- 52584-037- KETALAR
  - 52584-037-10- 1 VIAL in 1 BAG (52584-037-10) > 20 mL in 1 VIAL

52584- General Injectables and Vaccines, Inc
- 52584-038- KETAMINE HYDROCHLORIDE
  - 52584-038-10- 1 VIAL in 1 BAG (52584-038-10) > 10 mL in 1 VIAL

52584- General Injectables and Vaccines, Inc
- 52584-040- KETAMINE HYDROCHLORIDE
  - 52584-040-05- 1 VIAL, MULTI-DOSE in 1 BAG (52584-040-05) > 5 mL in 1 VIAL, MULTI-DOSE

52584- General Injectables and Vaccines, Inc.
- 52584-108- KETAMINE HYDROCHLORIDE
  - 52584-108-00- 1 VIAL, MULTI-DOSE in 1 BAG (52584-108-00) > 10 mL in 1 VIAL, MULTI-DOSE

67457- Mylan Institutional LLC
- 67457-001- Ketamine Hydrochloride
  - 67457-001-10- 10 VIAL in 1 CARTON (67457-001-10) > 10 mL in 1 VIAL (67457-001-00)

67457- Mylan Institutional LLC
- 67457-108- Ketamine Hydrochloride
  - 67457-108-10- 10 VIAL in 1 CARTON (67457-108-10) > 10 mL in 1 VIAL (67457-108-00)

67457- Mylan Institutional LLC
- 67457-181- Ketamine Hydrochloride
  - 67457-181-20- 10 VIAL in 1 CARTON (67457-181-20) > 20 mL in 1 VIAL (67457-181-00)

72572- Civica, Inc.
- 72572-320- Ketamine Hydrochloride
  - 72572-320-10- 10 VIAL in 1 BOX (72572-320-10) > 10 mL in 1 VIAL (72572-320-01)

72572- Civica, Inc.
- 72572-321- Ketamine Hydrochloride
  - 72572-321-10- 10 VIAL in 1 BOX (72572-321-10) > 5 mL in 1 VIAL (72572-321-01)

ROUTE	ONSET	PEAK	DURATION
IV	30 sec	unknown	5–10 min
IM	3–4 min	unknown	12–25 min

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇