Excellent and safe sedative and analgesic with a short duration of action for the ED. Manages pain and procedural sedation.
- Check BNF or equivalent for UpToDate prescribing advice
- Induction agent
- Can be abused as a recreational drug
- Derivative of phenycylidine
- High lipid solubility
- Non-competitive antagonism at the N-methyl-d-aspartate (NMDA) receptor Ca2 + channel pore
Mode of action
- Duration of action is about 15-30 minutes
- Increased sympathetic drive
- Induction agent especially with bronchospasm, cardiovascular instability and Burns
- Onset 15-30 seconds and recovery 15-30 min
Use for Sedation
- IM: For Adult: 6.5-13 mg/kg IM adjusted according to response, a dose of 10 mg/kg IM usually produces 12-25 minutes of surgical anaesthesia.
- IV: For Adult: 1-4.5 mg/kg IV adjusted according to response, to be administered over at least 60 seconds, a dose of 2 mg/kg usually produces 5-10 minutes of surgical anaesthesia.
- IV: Often an initial dose of 1mg/kg is used for sedation with the further top-up doses may be considered
- Shock, dehydrated, elderly, head injury, raised ICP, Seizures
- Severe anaemia, haemorrhage
- Young children, Unstable airway, Porphyria, significant cardiac disease
- Psychotic illness in past, psychological issues
- Acute porphyrias, (pre) Eclampsia, head trauma, HTN, raised ICP, stroke
- Hallucinations, nightmares and other transient psychotic effects.
- Raised HR and BP, bronchodilation
- Laryngospasm, Respiratory secretions