Makindo Medical Notes.com

Excellent and safe sedative and analgesic with a short duration of action for the ED. Manages pain and procedural sedation.

About: Always check the BNF link here

• Check BNF or equivalent for UpToDate prescribing advice
• Induction agent
• Can be abused as a recreational drug

Basics

• Derivative of phencyclidine
• 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
• Analgesia
• Sedation
• Amnesia
• Increased sympathetic drive

Indication/Dose

• 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

Interactions

• See BNF

Cautions

• Shock, dehydrated, elderly, head injury, raised ICP, Seizures
• Severe anaemia, haemorrhage

Contraindications

• Young children, Unstable airway, Porphyria, significant cardiac disease
• Psychotic illness in past, psychological issues
• Acute porphyrias, (pre) Eclampsia, head trauma, HTN, raised ICP, stroke

Side effects

• Hallucinations, nightmares and other transient psychotic effects.
• Raised HR and BP, bronchodilation
• Laryngospasm, Respiratory secretions

References

• Ketamine BNF

Revisions