Ketamine

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
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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. 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.

Further Reading

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