Difference between revisions of "Ketamine"

Latest revision as of 04:58, 4 April 2021

Ketamine is a dissociative anesthetic agent^[1] used for induction and maintenance of general anesthesia, sedation, and analgesia.

See: induction agents, maintenance of anesthesia, and sedation agents?

Uses, Dosing, & Administration

Induction of anesthesia:

IV over 30 to 60 seconds 1 to 2 mg/kg (LBW)
- 0.5 to 1 mg/kg in patients with shock
IM 4 to 6 mg/kg

Maintenance of anesthesia (adjunct to TIVA or inhalational anesthesia)

Various regimens exist:

0.075 mg/kg at incision followed by

0.25 to 0.35 mg/kg at incision, followed by continuous infusion up to 1 mg/kg/hour

Special Populations

Pediatrics

Elderly

Renal Impairment

Hepatic Impairment

Contraindications, Warnings, & Interactions

Absolute contraindications

Precautions

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.

Pregnancy & Breastfeeding

Drug Interactions

Disease-Specific Concerns

Adverse Effects

Myocardial ischemia, PAP, CBF

Pharmacology

Mechanism of action

Pharmacodynamics

Pharmacokinetics

Further Resources

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

↑ Corssen, G.; Domino, E. F. (1966-01). "Dissociative anesthesia: further pharmacologic studies and first clinical experience with the phencyclidine derivative CI-581". Anesthesia and Analgesia. 45 (1): 29–40. ISSN 0003-2999. PMID 5325977. Check date values in: |date= (help)

[1] Corssen, G.; Domino, E. F. (1966-01). "Dissociative anesthesia: further pharmacologic studies and first clinical experience with the phencyclidine derivative CI-581". Anesthesia and Analgesia. 45 (1): 29–40. ISSN 0003-2999. PMID 5325977. Check date values in: |date= (help)

[1]

@@ Line 1: / Line 1: @@
-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, 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>.
+**0.5 to 1 mg/kg in patients with shock
+*IM '''4 to 6 mg/kg'''
-- Asthma
+======Maintenance of anesthesia (adjunct to TIVA or inhalational anesthesia)======
+Various regimens exist:
-- Emergency semi-conscious intubation
+* 0.075 mg/kg at incision followed by
-{| class="wikitable"
-|+
-!
-!Adult
-!Pediatric
-!Administration Notes
-|-
-|Induction of anesthesia
-|IV
-.5 to 2 mg/kg
+*'''0.25 to 0.35 mg/kg''' at incision, followed by continuous infusion '''up to 1 mg/kg/hour'''
-.5 to 1 mg/kg in patients with shock
+===Special Populations===
-IM
+====Pediatrics====
-to 6 mg/kg
+====Elderly====
-|IV
-to 3 mg/kg
+====Renal Impairment====
-IM
+====Hepatic Impairment====
+==Contraindications, Warnings, & Interactions<!-- List contraindications and precautions for use of the drug. -->==
-to 10 mg/kg
+===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===
-|
-|-
-|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
+===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->===
-|Supplemental doses of one-half to the full induction dose as needed
+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.
-|
-|-
-|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====
+===Pregnancy & Breastfeeding<!-- If appropriate, give the drug's safety in pregnancy and for those breastfeeding -->===
-====Dosing in the Elderly====
+===Drug Interactions===
-====Dosing in Obesity====
+===Disease-Specific Concerns===
-====Dosing in Renal Impairment====
+==Adverse Effects==
+Myocardial ischemia, PAP, CBF
-====Dosing in Hepatic Impairment====
+==Pharmacology==
-==Contraindications and Warnings<!-- List contraindications and precautions for use of the drug. -->==
-===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 -->===
-====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. -->===
+==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.
 ==References==
 [[Category:Drug reference]]