Ketamine
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| Type | Dissociative anaesthetic agent
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| Presentation | 200 mg in 2ml vial
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| Actions | Complex, multiple actions: 1. Analgesic; sedative agent 2. Marked amnesia 3. Has bronchodilating properties 4. Does not tend to cause respiratory depression 5. Does not tend to cause hypotension (via sympathetic stimulation)Onset of action is rapid:
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| Uses | 1. Pain management, esp in pts who are hypotensive or unable to have narcotics, &no alternative is available 2 Particularly useful for trapped pts w/ limb injuries esp if BP is borderline for narcotics 3 Adjunct to Morphine, w/ alternating doses.
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| Adv Effects | 1. Transient Laryngospasm 2. Hypersalivation 3. Emergence reactions 4. Muscle twitching & purposeless movements 5. Occasionally respiratory depression → apnoea 6. Occasionally hypotension if given rapidly to a hypovolaemic pt
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| Precautions | 1. Use with care in patients where a rise in BP may be hazardous (e.g. stroke, cerebral trauma) 2. Known glaucoma 3. Previous psychoses 4. Hyperthyroidism 5. Elderly and paediatric patients 6. Patients previously administered narcotics
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| Contraindications | 1. Known sensitivity 2. Active cardiac disease (myocardial ischaemia, LVF, uncontrolled hypertension.) 3. Children under 1 year old
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| Special note | Pts who have received K may still have significant awareness, despite appearance of unconsciousness. They may hear and have some recall. Pts should be advised of strange/unusual sensations Pts who become agitated managed with small rpt doses of Midaz
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| Adult Dose IV | Up to 1mg/kg, incr of up to 20mg at 30-60s. Rpt after 5-10min, no upper limit. Prev opiates up to 10mg/kg
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| Adult Dose IM | 1mg/kg, rpt after 5-10min prev opiates 0.5mg/kg
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| Elderly>65yo Dose IV | up to 1mg/kg, inc of 10mg at 30-60s Rpt after 5-10min, 10mg incr, no upper limit Prev opiates: up to 5mg incr
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| Elderly>65kg Dose IM | 0.5mg/kg, rpt after 5-10min
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| Paediatric >20kg dose IV | Up to 1mg/kg, incr of 10mg at 30-60s Rpt after 5-10 min, incr of 10mg, no upper limit Prev opiates up to 5mg incr
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| Paediatric >20kg dose IM | o.5mg/kg, rpt after 5-10min prev opiates 0.25mg/kg
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| Paediatric <20kg dose IV | Up to 1mg/kg, incr of up to 5mg at 30-60s Rpt after 5-10min, incr of 5mg, no upper limit
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| Paediatric <20kg dose IM | 0.5mg/kg, rpt after 5-10min
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| Paediatric <20kg dose IV | Up to 1mg/kg, incr of up to 5mg at 30-60s Rpt after 5-10min, incr of 5mg
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