KETAMINE

General anaesthetic

Dosage Forms

Solution for injection

50 mg/ml

Uses

  • Induction of anaesthesia
  • Maintenance of anaesthesia
  • Analgesia for painful procedures of short duration

Dose and Duration

Induction and maintenance of anaesthesia and analgesia in short procedures
Adult and child over 12 years: by IM injection 6.5–13 mg/kg adjusted according to response (10mg/kg produces 12–25 minutes of surgical anaesthesia); maintenance, 50–100% of induction dose as required

In diagnostic and procedures not involving intense pain, use 4 mg/kg

By IV injection over at least 1 minute, 1–4.5 mg/kg adjusted according to response (2 mg/kg usually produces 5–10 minutes of surgical anaesthesia); maintenance, 50–100% of induction dose as required
Neonate and child up to 12 years: by IV injection over at least 60 seconds, 1–2 mg/kg produces 5–10 minutes of surgical anaesthesia, adjusted according to response
Induction and maintenance of anaesthesia and analgesia: longer procedures
Adult and child over 12 years: by IV infusion with solution containing 1 mg/ml in dextrose 5% or normal saline, total induction dose 0.5–2 mg/kg; maintenance (using microdrip infusion) 0.01 0.045 mg/kg/minute, rate adjusted according to response
Child up to 18 years: 0.5–2 mg/kg by IV injection, fol lowed by continuous IV infusion of 0.01–0.045 mg/kg /minute adjusted according to response
Neonate: 0.5–2 mg/kg by IV injection, followed by continuous IV infusion of 0.008 mg/kg /minute adjusted according to response. In deep anaesthesia, up to 0.03 mg/kg/minute may be used
Sedation prior to invasive or painful procedures
Child 1 month–18 years: 1–2 mg/kg as a single dose

Contraindications

  • Thyrotoxicosis
  • Hypertension including pre-eclampsia or eclampsia
  • Severe coronary or myocardial disease
  • History of cerebrovascular accident, cerebral trauma, intracerebral mass or haemorrhage or other cause of raised intracranial pressure
  • Eye injury
  • Increased intraocular pressure
  • Psychiatric disorders particularly hallucinations
  • Porphyria
  • Known hypersensitivity to ketamine

Side Effects

  • Hallucinations, confusion, agitation, abnormal behaviour
  • Transient elevation of pulse rate and blood pressure, increased respiratory rate
  • Diplopia, nystagmus
  • Tonic-clonic movements, hypertonia
  • Rash, erythema
  • Nausea, vomiting

Interactions

  • Chlorpromazine (enhanced hypotensive effect)
  • Fluphenazine (enhanced hypotensive effect)
  • Haloperidol (enhanced hypotensive effect)
  • Verapamil (enhanced hypotensive effect and atrioventricular delay)
  • Memantine (increased risk of CNS toxicity)

Patient Instructions

  • Do not perform any skilled tasks like driving within 24 hours of use of ketamine
  • Avoid taking alcohol within 24 hours of treatment
  • Do not take anything by mouth for at least 6 hours before anaesthesia

Pregnancy

  • Do not use in 3rd trimester

Breastfeeding

  • Can be used

⚠️ Caution

  • Ketamine crosses the placenta and depresses neonatal respiration when used in the 3rd trimester of pregnancy
  • Avoid breast-feeding for at least 12 hours after last dose
  • Requires administration of antisialagogue like hyoscine, atropine or glycopyrrolate to prevent excessive salivation and respiratory difficulties
  • Benzodiazepines such as midazolam and diazepam reduce incidence of emergence reactions
  • Patient under recovery must remain undisturbed but under observation
  • Consider dose reduction in hepatic impairment
  • Should be used in presence of resuscitative equipment
  • Ketamine should not be used for long-term use