Difference between revisions of "Ketamine"
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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, | 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. | ||
- | * 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 | |||
=== 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. | |||
Various regimens exist, e.g.: | |||
0.5 to 1 mg/kg | * 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 | |||
Satsumae T, Yamaguchi h, Sakaguchi M, et al. (2001). Preoperative small dose ketamine pre- | |||
vented tourniquet induced arterial pressure increase in orthopaedic patients under general anes- | |||
thesia. Anesth Analg, 92, 1286–9. | |||
18 Kam PC, Kavanaugh R, Yoong FF (2001). The arterial tourniquet: pathophysiological conse- | |||
quences and anaesthetic implications. Anaesthesia, 56, 534–6. | |||
====Dosing in Pediatrics ==== | |||
====Dosing in | ====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 /> | |||
Revision as of 16:53, 7 March 2021
Ketamine is a dissociative anesthetic and analgesic used for induction and maintenance of general anesthesia, sedation, and as an analgesic.
Ketamine
| Clinical data | |
| Pharmacodynamics | |
| Pharmacokinetics | |
| Physical and chemical data | |
| Article information | |
| Editor rating | |
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| Top authors | |
| Stuart van der Greeff | |
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, critically unwell patients with impaired catecholamine release or response may still become hypotensive following induction[1][2]. May also be chosen for patients with severe asthma due to potential bronchodilatory effect.
- 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
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.
Various regimens exist, e.g.:
- 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
Satsumae T, Yamaguchi h, Sakaguchi M, et al. (2001). Preoperative small dose ketamine pre-
vented tourniquet induced arterial pressure increase in orthopaedic patients under general anes-
thesia. Anesth Analg, 92, 1286–9.
18 Kam PC, Kavanaugh R, Yoong FF (2001). The arterial tourniquet: pathophysiological conse-
quences and anaesthetic implications. Anaesthesia, 56, 534–6.
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
- ↑ April, Michael D.; Arana, Allyson; Schauer, Steven G.; Davis, William T.; Oliver, Joshua J.; Fantegrossi, Andrea; Summers, Shane M.; Maddry, Joseph K.; Walls, Ron M.; Brown, Calvin A.; the NEAR Investigators (2020-11). Reardon, Robert (ed.). "Ketamine Versus Etomidate and Peri‐intubation Hypotension: A National Emergency Airway Registry Study". Academic Emergency Medicine. 27 (11): 1106–1115. doi:10.1111/acem.14063. ISSN 1069-6563. Check date values in:
|date=(help) - ↑ Miller, Matthew; Kruit, Natalie; Heldreich, Charlotte; Ware, Sandra; Habig, Karel; Reid, Cliff; Burns, Brian (2016-08). "Hemodynamic Response After Rapid Sequence Induction With Ketamine in Out-of-Hospital Patients at Risk of Shock as Defined by the Shock Index". Annals of Emergency Medicine. 68 (2): 181–188.e2. doi:10.1016/j.annemergmed.2016.03.041. Check date values in:
|date=(help)