Ketamine

Indications
 Intravenous
Induction of anaesthesia
Adult: 1-4.5 mg/kg as IV inj. Surgical anaesthesia is produced within 30 sec of the end of inj. Usual dose to produce 5-10 minutes of anaesthesia: 2 mg/kg over 60 seconds. Alternatively, 1-2 mg/kg infused at 0.5 mg/kg/minute; may use with diazepam to prevent emergence reactions.
Child: 1-4.5 mg/kg as IV Inj. Surgical anaesthesia is produced within 30 sec of the end of inj and lasts for 5-10 min if 2 mg/kg is given over 60 sec. Alternatively, 0.5-2 mg/kg as IV infusion. Maintenance: Achieve with 10-45 mcg/kg/min; titrate infusion rate according to response.
Intramuscular
Induction of anaesthesia
Adult: 6.5-13 mg/kg. Usual dose to produce 12-25 minutes of anesthesia: 10 mg/kg.

Incompatibility: May form precipitates with barbiturates; do not inject in the same syringe.
Contraindications
 Hypertension, history of cerebrovascular accident. Eye injury, raised ocular and intracranial pressure. Psychotic disorders.
Warnings / Precautions
 Minimise verbal and tactile stimulation during recovery period. Chronic alcoholic and alcohol-intoxicated patients. Preanaesthetic elevated CSF pressure. Dependence and tolerance may develop. May impair ability to drive or operate machinery. Monitor cardiac function in patients with hypertension or cardiac decompensation. Pregnancy and lactation.
Adverse Reactions
 Emergence reactions e.g. vivid dreams, hallucinations, confusion, irrational behaviour. Increased muscle tone sometimes resembling seizures. Temporary hypertension and tachycardia. Hypotension, bradycardia, arrhythmias. Respiratory depression, apnoea, laryngospasm, diplopia, nystagmus, nausea, vomiting, lachrymation, hypersalivation, raised intraocular and CSF pressure, skin rash and pain at inj site.
Drug Interactions
 May increase effects of nondepolarising muscle relaxants. May reduce hypnotic effect of thiopental. Prolonged recovery time with barbiturates/narcotics. Reduced cardiac output, BP and pulse rate with halothane. Increased risk of hypertension and tachycardia with thyroid hormones. Seizures and tachycardia may occur when used with theophyllines.
See Below for More ketamine Drug Interactions
Mechanism of Actions
 Ketamine has a direct action on the cortex and limbic system. It produces a cataleptic-like state wherein the patient is withdrawn from the surrounding environment.
Distribution: Crosses the placenta.
Metabolism: Hepatic biotransformation to norketamine. Other metabolic pathways include hydroxylation of the cyclohexone ring and conjugation with glucuronic acid.
Excretion: Via urine (as metabolites); 2.5 hr (beta phase half-life).
Storage Conditions
 Intramuscular: Store at 15-30°C (59-86°F). Intravenous: Store at 15-30°C (59-86°F).
ATC Classification
 N01AX03 - ketamine ; Belongs to the class of other general anesthetics.
Storage
 Intramuscular: Store at 15-30°C (59-86°F). Intravenous: Store at 15-30°C (59-86°F).
Available As
  • Ketamine 10 mg
  • Ketamine Hcl 10 mg
  • Ketamine 100 mg
  • Ketamine 25 mg
  • Ketamine 50 mg
  • Ketamine Hcl 50 mg
  • Ketamine Hcl 500 mg

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