No

General Anesthetic

Induction of anesthesia; short surgical procedures; dressing changes

C-III

D

Elevated intracranial pressure; patients with hypertension, aneurysms, thyrotoxicosis, congestive heart failure, angina, psychotic disorders; hypersensitivity to ketamine or any component

Should be used by or under the direct supervision of physicians experienced in administering general anesthetics and in maintenance of an airway, and in the control of respiration. Resuscitative equipment should be available for use.

>10%:

Cardiovascular: Hypertension, tachycardia, increased cardiac output, paradoxical direct myocardial depression

Central nervous system: Increased intracranial pressure, vivid dreams, visual hallucinations

Neuromuscular & skeletal: Tonic-clonic movements, tremors

Miscellaneous: Emergence reactions, vocalization

1% to 10%:

Cardiovascular: Bradycardia, hypotension

Dermatologic: Pain at injection site, skin rash

Gastrointestinal: Vomiting, anorexia, nausea

Ocular: Nystagmus, diplopia

Respiratory: Respiratory depression

<1%: Cardiac arrhythmias, myocardial depression, increased intracranial pressure, increases in cerebral blood, increased metabolic rate, increased intraocular pressure, hypersalivation, increased skeletal muscle tone, fasciculations, increased intraocular pressure, increased airway resistance, cough reflex may be depressed, decreased bronchospasm, apnea with large doses or rapid infusions, laryngospasm

Symptoms of overdose include respiratory depression with excessive dosing or too rapid administration

Supportive care is the treatment of choice; mechanical support of respiration is preferred

CYP3A enzyme substrate

Increased toxicity: Muscle relaxants, thyroid hormones may increase blood pressure and heart rate; halothane may decrease BP

Do not mix with barbiturates or diazepam precipitation may occur

Produces dissociative anesthesia by direct action on the cortex and limbic system

Duration of action (following a single dose):

Analgesia: I.M.: 15-30 minutes

Amnesia: May persist for 1-2 hours

Recovery: I.M.: 3-4 hours; I.V.: 1-2 hours

Used in combination with anticholinergic agents to decrease hypersalivation

Oral: 6-10 mg/kg for 1 dose (mixed in 0.2-0.3 mL/kg of cola or other beverage) given 30 minutes before the procedure

I.M.: 3-7 mg/kg

I.V.: Range: 0.5-2 mg/kg, use smaller doses (0.5-1 mg/kg) for sedation for minor procedures; usual induction dosage: 1-2 mg/kg

Continuous I.V. infusion: Sedation: 5-20 mcg/kg/minute

Adults:

I.M.: 3-8 mg/kg

I.V.: Range: 1-4.5 mg/kg; usual induction dosage: 1-2 mg/kg

Children and Adults: Maintenance: Supplemental doses of 1/3 to 1/2 of initial dose

I.V.: Do not exceed 0.5 mg/kg/minute or give faster than 60 seconds; do not exceed final concentration of 2 mg/mL

Cardiovascular effects, heart rate, blood pressure, respiratory rate, transcutaneous O₂ saturation

Vivid dreams and hallucinations common

Contraindicated in patients with psychotic disorders; barbiturates and hydroxyzine may increase the effects of ketamine; avoid combination

No information available to require special precautions

No effects or complications reported

Injection, as hydrochloride: 10 mg/mL (20 mL, 25 mL, 50 mL); 50 mg/mL (10 mL); 100 mg/mL (5 mL)

Clements JA and Nimmo WS, "Pharmacokinetics and Analgesic Effect of Ketamine in Man," Br J Anaesth, 1981, 53:27-30.

Cote CJ, "Sedation for the Pediatric Patient: A Review," Pediatr Clin North Am, 1994, 41(1):31-58.

Felser JM and Orban DJ, "Dystonic Reaction After Ketamine Abuse," Ann Emerg Med, 1982, 11:673-5.

Glickman A, "Ketamine: The Dissociative Anesthetic and the Development of a Policy for Its Safe Administration in the Pediatric Emergency Department," J Emerg Nurs, 1995, 21(2):116-24.

Gutstein HB, Johnson KL, Heard MN, et al, "Oral Ketamine Premedication in Children," Anesthesiology, 1992, 76(1):28-33.

Hartvig P, Valtysson J, Lindner KJ, et al, "Central Nervous System Effects of Subdissociative Doses of ( S)-Ketamine Are Related to Plasma and Brain Concentrations Measured With Positron Emission Tomography in Healthy Volunteers," Clin Pharmacol Ther, 1995, 58(2):165-73.

Kohrs R and Durieux ME, "Ketamine: Teaching an Old Drug New Tricks," Anesth Analg, 1998, 87(5):1186-93.

Mercadante S, "Ketamine in Cancer Pain: An Update," Palliat Med, 1996, 10(3):225-30.

Moro-Sutherland DM and Shook JE, "Ketamine Use in a Pediatric Emergency Room," Acad Emerg Med, 1995, 2:428-9.

Tobias JD and Rasmussen GE, "Pain Management and Sedation in the Pediatric Intensive Care Unit," Pediatr Clin North Am, 1994, 41(6):1269-92.

Tobias JD, Phipps S, Smith B, et al, "Oral Ketamine Premedication to Alleviate the Distress of Invasive Procedures in Pediatric Oncology Patients," Pediatrics, 1992, 90(4):537-41.

Winters WD, "Epilepsy or Anesthesia With Ketamine," Anesthesiology, 1972, 36:309-12.