Ketamine hydrochloride

Question 1

What is the trade name for ketamine hydrochloride?

Answer 1

Ketalar

Question 2

What is the drug classification of ketamine hydrochloride?

Answer 2

Dissociative anesthetic, analgesic

Question 3

Describe the MOA (pharmacodynamics) for ketamine hydrochloride.

Answer 3

• Induces dissociative effects by direct action on the cortex of the limbic system.
• Ketamine-induced catecholamine release helps maintain blood pressure.
• Produces analgesia, sedation, immobility and amnesia while preserving respiratory drive and airway protective reflexes in lower doses; general anesthesia in higher doses.

Question 4

What are the Indications for use of ketamine hydrochloride?

Answer 4

• MFI (ideal drug with systolic < 90mmHg or associated bronchospasm)
• Induction of general anesthesia for short procedures not requiring skeletal muscle relaxation.
• Maintain sedation post advanced airway management
• Pain management
• Combative patients, (better in head injury patients)

Question 5

What is the dosing for ketamine hydrochloride for MFI?

Answer 5

1 - 2 mg/kg IVP (use lower doses for difficult intubation and/or in patients at risk for hypotension)

Question 6

What is the ketamine dosing for procedural sedation?

Answer 6

0.5 – 1.0mg/kg SIVP/IM; titrate to desired effect.

Question 7

What is the ketamine maintenance dosing post MFI?

Answer 7

0.5 – 1.5mg/kg SIVP q5 minutes

Question 8

What is the ketamine dosing for pain management?

Answer 8

0.2 – 0.3mg/kg SIVP/IO/IM prn q5

9-10mg/kg IN prn q5

Question 9

What is the dosing for a ketamine infusion?

Answer 9

0.5 – 1.5mg/kg/hr, start low and work your way up.

Analgesic doses are low, maintenance of sedation doses are higher. Used for transport 30+ minutes.

Question 10

What are the Relative Contraindications to the use of Ketamine Hydrochloride?

Answer 10

• Severe hypertension; Aneurysms

- Conditions where a significant elevation of BP is hazardous; acute heart failure, angina, recent MI

Question 11

What are some precautions for ketamine use?

Answer 11

Ketamine may cause hallucinations and delusions that could exacerbate schizophrenia or other acute psychosis episodes. Give Versed to relax them.

Question 12

How do you set up for a ketamine infusion?

Answer 12

Mix 200mg in 100ml NS or D5W giving you a

concentration of 2mg/ml.

Question 13

What can happen if ketamine is given too fast?

Answer 13

Apnea, aspiration and laryngospasm have been reported

Question 14

When indicated, why may ketamine be favourable in patients who are hypotensive?

Answer 14

It’s known to increases heart rate and blood pressure. This could make it favorable in patients that are hypotensive (but not hypovolemic).

Question 15

Why is ketamine the drug of choice for intubation of bronchospasm patients?

Answer 15

It has limited or no respiratory depression, it also has B2 agonist and antihistamine properties.

Question 16

Why must you always have a suction unit available and ready for use when giving ketamine?

Answer 16

It can induce hypersalivation and tracheal-bronchial secretions.

Question 17

Why may atropine have to be given during treatment with ketamine?

Answer 17

In the case of hypersalivation and tracheal-bronchial secretions, atropine may need to be given to dry up the secretions.

Question 18

How is ketamine hydrochloride supplied?

Answer 18

10 mg/mL, 50 mg/mL, and 100 mg/mL (ampules)