Ketamine

Section 8 - MEDICATION GUIDELINES

ANESTHETICS

Ketamine / Anesthetic

DESCRIPTION

• Dissociative anesthetic, Systemic. Schedule III controlled substance.

INDICATIONS

• Sedation in the extremely agitated patient
• Musculoskeletal Pain / Extremity Pain
• Combative Post Resuscitation

CONTRAINDICATIONS

• Hypersensitivity
• Penetrating eye injury.
• Pregnancy
• Due to sympathomimetic effects, contraindicated in patients with known, severe CAD (for example, patients currently experiencing STEMI).

PRECAUTIONS

• Have ventilatory support readily available
• There is no known antidote or reversal agent for Ketamine
• Emergence Reaction - Read "Special Note" at RxList - Ketamine
  • If this occurs give Benzodiazepine.
    • DIAZEPAM (VALIUM) 2 - 20 mg SLOW IVP or IM to desired effect.
    • MIDAZOLAM (VERSED) 2 - 10 mg IV, IO or IN, titrated to effect.

DOSAGE

• Titrate to effect, starting dose of 0.5 mg/kg slow IVP or 1 mg/kg IM.

Onset of action:

• IM administration: 3 – 5 minutes
• IV administration: 1- 2 minutes

Duration of action:

• 20 – 40 minutes when dosed at 4mg/kg IM.
• 12 – 20 minutes when dosed at 2mg/kg IV.

Side Effects:

• Hypertension, emesis, laryngospasm, tachycardia, bronchodilation, increased salivation, emergence reaction (12%).