Ketamine

Question 1

What are the indications of Ketamine?

Answer 1

• Intubation
• Analgesia
• Sedation (agitation, patient movement during CPR)

Question 2

What are the contraindications of Ketamine?

Answer 2

• Suspected non-traumatic brain injury with severe hypertension (SBP >180)

Question 3

What are some precautions of Ketamine?

Answer 3

• May exacerbate CV conditions (eg. Uncontrolled hypertension, stroke, recent MI, cardiac failure due to effects on HR and BP

Question 4

What are some side effects of Ketamine?

Answer 4

• Hypertension
• Tachycardia
• Emergence reactions (hallucinations, restlessness, irrational behaviour)
• Nausea/vomiting
• Increased skeletal muscle tone (may resemble seizures)
• Transient respiratory depression
• Apnoea
• Hypersalivation
• Dyplopia (double vision)
• Nystagmus (uncontrolled eye movement)

Question 5

What are the dosages of Ketamine?

Answer 5

• Analgesic dose, Consult only. 10-25mg at 5-10min intervals IV
• Procedural dose, 20-30mg at 2min intervals until analgesia adequate IV
• Infusion, 0.1-0.3mg/kg/he IV
• 75mg (repeat 50mg at 20min intervals) No max dose IN
• F/E/<60kg 50mg (repeat 25mg at 20min intervals) No max dose IN
• Ketamine IM using the IV dose where IV and IN unavailable

Question 6

What are the dilutions of Ketamine?

Answer 6

• Dilute Ketamine 200mg/2mL to 20mL with 18mL NS
  10mg/1mL
• Do not dilute IM
• Add 0.1mL for MAD IN

Question 7

What is the Onset, Peak and Duration of Ketamine?

Answer 7

IV
O - 30sec
D - 5-10min
IM
O - 3-4min
D - 12-25min
IN
O - 5min
P - 20min
D - 45min