Ketamine - Revision history

Stuart.vandergreeff at 11:58, 4 April 2021

2021-04-04T11:58:54Z

← Older revision		Revision as of 04:58, 4 April 2021
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	Ketamine is a dissociative anesthetic ~~and analgesic used for induction and maintenance of general~~ anesthesia~~, sedation,~~ and ~~as an analgesic.{{Infobox drug reference~~		Ketamine is a dissociative anesthetic agent<ref>{{Cite journal\|last=Corssen\|first=G.\|last2=Domino\|first2=E. F.\|date=1966-01\|title=Dissociative anesthesia: further pharmacologic studies and first clinical experience with the phencyclidine derivative CI-581\|url=https://pubmed.ncbi.nlm.nih.gov/5325977\|journal=Anesthesia and Analgesia\|volume=45\|issue=1\|pages=29–40\|issn=0003-2999\|pmid=5325977}}</ref> used for induction and maintenance of general anesthesia, sedation, and analgesia.
	\| ~~trade_names~~ =		See: induction agents, maintenance of anesthesia, and sedation agents?
	\| ~~drug_class~~ =
	\| ~~drug_class_color~~ =
	\| ~~uses~~ =
	\| ~~contraindications~~ =
	\| ~~routes~~ =
	\| ~~dosage~~ =
	}}

	==Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==		==Uses, Dosing, & Administration<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==
			======Induction of anesthesia:======

	~~===Induction of Anesthesia===~~		*IV over 30 to 60 seconds '''1 to 2 mg/kg''' (LBW)
	~~Ketamine is often chosen for induction of anesthesia in patients who are or are expected~~ to become hemodynamically unstable as it generally maintains or increases heart rate, blood pressure, and cerebral perfusion through stimulation of catecholamine release. However, critically unwell patients with impaired catecholamine release or response may still become hypotensive following induction<ref>{{Cite journal\|last=April\|first=Michael D.\|last2=Arana\|first2=Allyson\|last3=Schauer\|first3=Steven G.\|last4=Davis\|first4=William T.\|last5=Oliver\|first5=Joshua J.\|last6=Fantegrossi\|first6=Andrea\|last7=Summers\|first7=Shane M.\|last8=Maddry\|first8=Joseph K.\|last9=Walls\|first9=Ron M.\|last10=Brown\|first10=Calvin A.\|last11=the NEAR Investigators\|date=2020-11\|editor-last=Reardon\|editor-first=Robert\|title=Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study\|url=https:/~~/onlinelibrary~~.~~wiley.com/doi/10.1111/acem.14063\|journal=Academic Emergency Medicine\|language=en\|volume=27\|issue=11\|pages=1106–1115\|doi=10.1111/acem.14063\|issn=1069-6563}}<~~/ref><ref>{{Cite journal\|last=Miller\|first=Matthew\|last2=Kruit\|first2=Natalie\|last3=Heldreich\|first3=Charlotte\|last4=Ware\|first4=Sandra\|last5=Habig\|first5=Karel\|last6=Reid\|first6=Cliff\|last7=Burns\|first7=Brian\|date=2016-08\|title=Hemodynamic Response After Rapid Sequence Induction With Ketamine in Out-of-Hospital Patients at Risk of Shock as Defined by the Shock Index\|url=https://linkinghub.elsevier.com/retrieve/pii/S0196064416300026\|journal=Annals of Emergency Medicine\|language=en\|volume=68\|issue=2\|pages=181–188.e2\|doi=10.1016/j.annemergmed.2016.03.041}}</ref>. May also be chosen for patients with ~~severe asthma due~~ to ~~potential bronchodilatory effect.~~		**0.5 to 1 mg/kg in patients with shock
			*IM '''4 to 6 mg/kg'''

	* IV: 0.5 to 2 mg/kg (~~0.5~~ to ~~1 mg/kg in patients with shock~~) ~~- administer over one minute~~		======Maintenance of anesthesia (adjunct to TIVA or inhalational anesthesia)======
	* IM: ~~4 to 6 mg/kg~~		Various regimens exist:

	~~=== Maintenance of Anesthesia ===~~		* 0.075 mg/kg at incision followed by
	Ketamine can be used as an adjunct to intravenous or inhalational analgesia to reduce requirement of other anesthetics, and reduce opioid requirements intra and postoperatively. It is particularly useful for patients who are tolerant to opioids.

	~~Various regimens exist, e~~.g.:		*'''0.25 to 0.35 mg/kg''' at incision, followed by continuous infusion '''up to 1 mg/kg/hour'''

	* 0.5 mg at incision, followed by 0.25 mg/kg/'''hour''' infusion
	* 0.25 to 0.35 mg/kg, followed by up to 1 mg/kg/'''hour''' infusion

	=== ~~Miscellaneous~~ ===		===Special Populations===
	~~0.25 mg/kg for tourniquet response~~

	~~Satsumae T, Yamaguchi h, Sakaguchi M, et al. (2001). Preoperative small dose ketamine pre-~~		====Pediatrics====

	~~vented tourniquet induced arterial pressure increase in orthopaedic patients under general anes-~~		====Elderly====

	~~thesia. Anesth Analg, 92, 1286–9.~~		====Renal Impairment====

	~~18 Kam PC~~, ~~Kavanaugh R~~, ~~Yoong FF (2001)~~. ~~The arterial tourniquet: pathophysiological conse~~-		====Hepatic Impairment====
			==Contraindications, Warnings, & Interactions<!-- List contraindications and precautions for use of the drug. -->==

	~~quences and anaesthetic implications~~. ~~Anaesthesia~~, ~~56, 534–6~~.		===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===

	===~~=Dosing in Pediatrics =~~===		===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->===
			ith cardiogenic shock caused by myocardial ischemia because the increases in HR and BP may detrimentally unbalance myocardial oxygen supply versus demand. Also, the sympathomimetic effects of ketamine may detrimentally increase pulmonary artery pressure (PAP) in patients with pulmonary hypertension or right-sided heart failure.

	===~~=Dosing~~ in ~~the Elderly =~~===		===Pregnancy & Breastfeeding<!-- If appropriate, give the drug's safety in pregnancy and for those breastfeeding -->===

	===~~=Dosing in Obesity =~~===		===Drug Interactions===

	===~~=Dosing in Renal Impairment=~~===		===Disease-Specific Concerns===

	====~~Dosing in Hepatic Impairment====~~		==Adverse Effects==
			Myocardial ischemia, PAP, CBF

	==~~Contraindications and Warnings<!-- List contraindications and precautions for use of the drug. -->==~~		==Pharmacology==

	~~===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===~~

	~~===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->=~~==

	===~~=Pregnancy & Breastfeeding~~<!-- ~~If appropriate, give~~ the drug~~'s safety in pregnancy and for those breastfeeding~~ -->=~~===~~		===Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->===

	~~====Drug Interactions====~~

	~~==Pharmacology~~==

	===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===		===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===

	~~====Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->====~~

	~~====Adverse effects<!-- Describe any potential adverse effects of the drug. -->====~~

	===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===		===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===
			==Further Resources==
	~~==Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. -->==~~

	~~==History<!-- Describe the historical development of the drug. -->==~~
	==Further ~~Reading~~==
	You can use this section to provide sources that offer further information that may be of interest to users. Present them as a bulleted list and give a brief description of the resource.		You can use this section to provide sources that offer further information that may be of interest to users. Present them as a bulleted list and give a brief description of the resource.
	==References ==		==References==

	[[Category:Drug reference]]		[[Category:Drug reference]]

	~~<references />~~

Stuart.vandergreeff at 23:53, 7 March 2021

2021-03-07T23:53:11Z

← Older revision		Revision as of 16:53, 7 March 2021
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	===Induction of Anesthesia===		===Induction of Anesthesia===
	Ketamine is often chosen for induction of anesthesia in patients who are or are expected to become hemodynamically unstable as it generally maintains or increases heart rate, blood pressure, and cerebral perfusion through stimulation of catecholamine release. However, ~~unstable~~ patients with impaired catecholamine release or response may still become hypotensive following induction<ref>{{Cite journal\|last=April\|first=Michael D.\|last2=Arana\|first2=Allyson\|last3=Schauer\|first3=Steven G.\|last4=Davis\|first4=William T.\|last5=Oliver\|first5=Joshua J.\|last6=Fantegrossi\|first6=Andrea\|last7=Summers\|first7=Shane M.\|last8=Maddry\|first8=Joseph K.\|last9=Walls\|first9=Ron M.\|last10=Brown\|first10=Calvin A.\|last11=the NEAR Investigators\|date=2020-11\|editor-last=Reardon\|editor-first=Robert\|title=Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study\|url=https://onlinelibrary.wiley.com/doi/10.1111/acem.14063\|journal=Academic Emergency Medicine\|language=en\|volume=27\|issue=11\|pages=1106–1115\|doi=10.1111/acem.14063\|issn=1069-6563}}</ref><ref>{{Cite journal\|last=Miller\|first=Matthew\|last2=Kruit\|first2=Natalie\|last3=Heldreich\|first3=Charlotte\|last4=Ware\|first4=Sandra\|last5=Habig\|first5=Karel\|last6=Reid\|first6=Cliff\|last7=Burns\|first7=Brian\|date=2016-08\|title=Hemodynamic Response After Rapid Sequence Induction With Ketamine in Out-of-Hospital Patients at Risk of Shock as Defined by the Shock Index\|url=https://linkinghub.elsevier.com/retrieve/pii/S0196064416300026\|journal=Annals of Emergency Medicine\|language=en\|volume=68\|issue=2\|pages=181–188.e2\|doi=10.1016/j.annemergmed.2016.03.041}}</ref>.		Ketamine is often chosen for induction of anesthesia in patients who are or are expected to become hemodynamically unstable as it generally maintains or increases heart rate, blood pressure, and cerebral perfusion through stimulation of catecholamine release. However, critically unwell patients with impaired catecholamine release or response may still become hypotensive following induction<ref>{{Cite journal\|last=April\|first=Michael D.\|last2=Arana\|first2=Allyson\|last3=Schauer\|first3=Steven G.\|last4=Davis\|first4=William T.\|last5=Oliver\|first5=Joshua J.\|last6=Fantegrossi\|first6=Andrea\|last7=Summers\|first7=Shane M.\|last8=Maddry\|first8=Joseph K.\|last9=Walls\|first9=Ron M.\|last10=Brown\|first10=Calvin A.\|last11=the NEAR Investigators\|date=2020-11\|editor-last=Reardon\|editor-first=Robert\|title=Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study\|url=https://onlinelibrary.wiley.com/doi/10.1111/acem.14063\|journal=Academic Emergency Medicine\|language=en\|volume=27\|issue=11\|pages=1106–1115\|doi=10.1111/acem.14063\|issn=1069-6563}}</ref><ref>{{Cite journal\|last=Miller\|first=Matthew\|last2=Kruit\|first2=Natalie\|last3=Heldreich\|first3=Charlotte\|last4=Ware\|first4=Sandra\|last5=Habig\|first5=Karel\|last6=Reid\|first6=Cliff\|last7=Burns\|first7=Brian\|date=2016-08\|title=Hemodynamic Response After Rapid Sequence Induction With Ketamine in Out-of-Hospital Patients at Risk of Shock as Defined by the Shock Index\|url=https://linkinghub.elsevier.com/retrieve/pii/S0196064416300026\|journal=Annals of Emergency Medicine\|language=en\|volume=68\|issue=2\|pages=181–188.e2\|doi=10.1016/j.annemergmed.2016.03.041}}</ref>. May also be chosen for patients with severe asthma due to potential bronchodilatory effect.

	- ~~Asthma~~		* IV: 0.5 to 2 mg/kg (0.5 to 1 mg/kg in patients with shock) - administer over one minute
			* IM: 4 to 6 mg/kg

	~~- Emergency semi-conscious intubation~~		=== Maintenance of Anesthesia ===
			Ketamine can be used as an adjunct to intravenous or inhalational analgesia to reduce requirement of other anesthetics, and reduce opioid requirements intra and postoperatively. It is particularly useful for patients who are tolerant to opioids.
	~~{\| class~~=~~"wikitable"~~
	\|+
	!
	~~!Adult~~
	~~!Pediatric~~
	~~!Administration Notes~~
	\|-
	~~\|Induction~~ of ~~anesthesia~~
	~~\|IV~~

	0.~~5 to 2 mg/kg~~		Various regimens exist, e.g.:

	0.5 to 1 mg/kg ~~in patients with shock~~		* 0.5 mg at incision, followed by 0.25 mg/kg/'''hour''' infusion
			* 0.25 to 0.35 mg/kg, followed by up to 1 mg/kg/'''hour''' infusion

			=== Miscellaneous ===
			0.25 mg/kg for tourniquet response

	IM		Satsumae T, Yamaguchi h, Sakaguchi M, et al. (2001). Preoperative small dose ketamine pre-

	~~4 to 6 mg/kg~~		vented tourniquet induced arterial pressure increase in orthopaedic patients under general anes-
	~~\|IV~~
	~~1 to 3 mg/kg~~

			thesia. Anesth Analg, 92, 1286–9.

	IM		18 Kam PC, Kavanaugh R, Yoong FF (2001). The arterial tourniquet: pathophysiological conse-

	~~5 to 10 mg/kg~~		quences and anaesthetic implications. Anaesthesia, 56, 534–6.
	\|
	\|-
	~~\|Adjunct during general anesthesia~~
	~~\|Various regimens exist:~~
	~~- 0~~.~~5 mg/kg bolus at incision~~, ~~followed by 0~~.~~25 mg/kg/'''hour''' infusion~~

	~~- 0.25 to 0.35 mg/kg bolus, followed by up to 1 mg/kg/'''hour''' infusion~~		====Dosing in Pediatrics ====
	~~\|Supplemental doses of one-half to the full induction dose as needed~~
	\|
	\|-
	~~\|Sedation~~
	~~\|0.1 to 0.5 mg/kg bolus, followed by a 0.2 to 0.5 mg/kg/'''hour''' infusion~~
	\|
	\|
	\|-
	~~\|Analgesia~~
	\|
	\|
	\|
	\|}

	====Dosing in ~~Pediatrics~~====		====Dosing in the Elderly ====

	~~====Dosing in the Elderly====~~		====Dosing in Obesity ====

	====Dosing in Obesity====

	====Dosing in Renal Impairment====		====Dosing in Renal Impairment====
Line 99:		Line 73:
	==Further Reading==		==Further Reading==
	You can use this section to provide sources that offer further information that may be of interest to users. Present them as a bulleted list and give a brief description of the resource.		You can use this section to provide sources that offer further information that may be of interest to users. Present them as a bulleted list and give a brief description of the resource.
	==References==		==References ==

	[[Category:Drug reference]]		[[Category:Drug reference]]

			<references />

Stuart.vandergreeff: Created page with "Ketamine is a dissociative anesthetic and analgesic used for induction and maintenance of general anesthesia, sedation, and as an analgesic.{{Infobox drug reference | trade_na..."

2021-03-07T23:13:29Z

Created page with "Ketamine is a dissociative anesthetic and analgesic used for induction and maintenance of general anesthesia, sedation, and as an analgesic.{{Infobox drug reference | trade_na..."

New page

Ketamine is a dissociative anesthetic and analgesic used for induction and maintenance of general anesthesia, sedation, and as an analgesic.{{Infobox drug reference
| trade_names =
| drug_class =
| drug_class_color =
| uses =
| contraindications =
| routes =
| dosage =
}}

==Uses==

===Induction of Anesthesia===
Ketamine is often chosen for induction of anesthesia in patients who are or are expected to become hemodynamically unstable as it generally maintains or increases heart rate, blood pressure, and cerebral perfusion through stimulation of catecholamine release. However, unstable patients with impaired catecholamine release or response may still become hypotensive following induction<ref>{{Cite journal|last=April|first=Michael D.|last2=Arana|first2=Allyson|last3=Schauer|first3=Steven G.|last4=Davis|first4=William T.|last5=Oliver|first5=Joshua J.|last6=Fantegrossi|first6=Andrea|last7=Summers|first7=Shane M.|last8=Maddry|first8=Joseph K.|last9=Walls|first9=Ron M.|last10=Brown|first10=Calvin A.|last11=the NEAR Investigators|date=2020-11|editor-last=Reardon|editor-first=Robert|title=Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study|url=https://onlinelibrary.wiley.com/doi/10.1111/acem.14063|journal=Academic Emergency Medicine|language=en|volume=27|issue=11|pages=1106–1115|doi=10.1111/acem.14063|issn=1069-6563}}</ref><ref>{{Cite journal|last=Miller|first=Matthew|last2=Kruit|first2=Natalie|last3=Heldreich|first3=Charlotte|last4=Ware|first4=Sandra|last5=Habig|first5=Karel|last6=Reid|first6=Cliff|last7=Burns|first7=Brian|date=2016-08|title=Hemodynamic Response After Rapid Sequence Induction With Ketamine in Out-of-Hospital Patients at Risk of Shock as Defined by the Shock Index|url=https://linkinghub.elsevier.com/retrieve/pii/S0196064416300026|journal=Annals of Emergency Medicine|language=en|volume=68|issue=2|pages=181–188.e2|doi=10.1016/j.annemergmed.2016.03.041}}</ref>.

- Asthma

- Emergency semi-conscious intubation

{| class="wikitable"
|+
!
!Adult
!Pediatric
!Administration Notes
|-
|Induction of anesthesia
|IV

0.5 to 2 mg/kg

0.5 to 1 mg/kg in patients with shock

IM

4 to 6 mg/kg
|IV
1 to 3 mg/kg

IM

5 to 10 mg/kg
|
|-
|Adjunct during general anesthesia
|Various regimens exist:
- 0.5 mg/kg bolus at incision, followed by 0.25 mg/kg/'''hour''' infusion

- 0.25 to 0.35 mg/kg bolus, followed by up to 1 mg/kg/'''hour''' infusion
|Supplemental doses of one-half to the full induction dose as needed
|
|-
|Sedation
|0.1 to 0.5 mg/kg bolus, followed by a 0.2 to 0.5 mg/kg/'''hour''' infusion
|
|
|-
|Analgesia
|
|
|
|}

====Dosing in Pediatrics====

====Dosing in the Elderly====

====Dosing in Obesity====

====Dosing in Renal Impairment====

====Dosing in Hepatic Impairment====

==Contraindications and Warnings==

===Absolute contraindications===

===Precautions===

====Pregnancy & Breastfeeding====

====Drug Interactions====

==Pharmacology==

===Pharmacodynamics===

====Mechanism of action====

====Adverse effects====

===Pharmacokinetics===

==Chemistry and formulation==

==History==
==Further Reading==
You can use this section to provide sources that offer further information that may be of interest to users. Present them as a bulleted list and give a brief description of the resource.
==References==

[[Category:Drug reference]]