Ketamine Flashcards
Ketamine - Type
Anaesthetic agent
Ketamine - Presentation
200mg in 2ml vial
Ketamine - Actions (5)
- Analgesic, sedative agent
- Marked amnesia
- Has bronchodilating properties
- Does not tend to cause respiratory depression
- Does not tent to cause hypotension (via sympathetic stimulation)
Onset IV 1-2 min, IM 3-5 min
Ketamine - Uses (5)
- Pain management, especially in pts who are hypotensive or unable to have narcotics, and if no other alternative is available
- Particularly useful for trapped pts with limb injuries, especially if BP is borderline for narcotics
- Adjunct to morphine, with alternating doses
- Pharmacological intervention for combative/agitated pts, especially with suspected psycho-stimulant use
- Sedation to manage airway, RSI, sedation of a previously intubated pt
Ketamine - Adverse effects (6)
- Transient laryngospasm
- Hypersalivation
- Emergence reactions
- Muscle twitching and purposeless movements
- Occasionally respiratory depression –> apnoea
- Occasionally hypotension if given too rapidly to a hypovolaemic pt.
Ketamine - Contraindications (3)
- Known sensitivity
- Active cardiac disease
- Children
Ketamine - Precautions (6)
- Use with care in pts where a rise in BP may be hazardous
- Known glaucoma
- Previous psychoses
- Hyperthyroidism
- Elderly and paediatric pts
- Pts previously administered narcotics
Ketamine - Doses (pain management)
All doses up to listed and (IV) increments of 30-60 sec
Adult - IV 1mg/kg in 20mg increments, rep 5-10/60 as req
- IM 1mg/kg, rep after 5-10 as req
- IV previous opioids 10mg increments
- IM previous opioids 0.5mg/kg
>65 yrs - IV 1mg/kg in 10mg increments, rep 5-10/60 as req
- IM 0.5mg/kg, rep after 5-10 as req
- IV previous opioids 5mg increments
- IM previous opioids 0.25mg/kg
Paed >20kg - IV 1mg/kg in 10mg increments, rep 5-10/60 as req
- IM 0.5mg/kg, rep after 5-10 as req
- IV previous opioids 5mg increments
- IM previous opioids 0.25mg/kg
Paed <20kg - IV 1mg/kg in 5mg increments, rep 5-10/60 as req
- IM 0.5mg/kg rep after 5-10 as req
- IV previous opioids 2.5mg increments
- IM previous opiods 0.25mg/kg
Ketamine - Doses (all except pain)
Combative/agitated pts
Adult & Paediatric - 1st line agent 4mg/kg IMI
- 2nd line agent 1.5mg/kg IV
IMI as single dose only, IV over 30 sec
With Suxamethonium
Adult - 1mg/kg IV fast push
Intubation when sux contraindicated
Adult - 2mg/kg IV fast push
Maintain sedation post intubation
Adult & Paediatric - 1mg/kg IV at 1-5min intervals titrated.
Ketamine - Special notes
Can be used with alternating doses of morphine for analgesia only
Pts may still have significant awareness despite appearance of unconsciousness
Pts who become agitated may be managed with small repeat doses of midazolam
Ketamine - recommended dilutions
Adult IV - 200mg to 10ml = 20mg/ml
Adult IM - 100mg to 2ml
Elderly IV - 100mg to 10ml = 10mg/ml
Elderly IM - 100mg to 2ml
Paed IV - 50mg to 10ml = 5mg/ml
Paed IM - 50mg to 2ml
