Details
Presentation:
200 mg / 2 mL glass ampoule
Route:
- IV (dilute ketamine 200 mg / 2 mL to 20 mL with 18 mL of Normal Saline (10 mg/mL).
- Administer IV doses slowly (over at least 1 minute); rapid administration may result in respiratory depression and enhanced hypertensive response
- IM (do not dilute)
- IN (add 0.1 mL to required volume to account for dead space in the MAD)
Onset of action:
- IV 30 seconds (anaesthesia)
- IM 3 – 4 minutes
- IN 5 minutes
Peak:
- IN 20 minutes
Duration:
- IV 5 – 10 minutes (anaesthesia)
- IM 12 – 25 minutes
- IN 45 minutes
Mode of action
Anaesthetic agent with analgesic properties at lower doses.
Exact mechanism of action is unclear, but primarily works as an antagonist at N-methyl-D-aspartate (NMDA) receptors. Ketamine may also interact with opioid, muscarinic and other receptors. Produces a trance-like dissociative state with amnesia, with preservation of laryngeal and pharyngeal reflexes.
- Intubation
- Analgesia
- Sedation:
- Agitation
- Patient movement during CPR
- Suspected non-traumatic brain injury with severe hypertension (SBP > 180)
- CV: hypertension, tachycardia
- CNS: emergence reactions (e.g. vivid dreams, restlessness, confusion, hallucinations, irrational behavior); increased skeletal muscle tone (may resemble seizures)
- Respiratory: transient respiratory depression and apnoea (rare)
- GI: nausea and vomiting
- Other: injection site pain, lacrimation, hypersalivation, diplopia, nystagmus
Significant interactions
- Nil
Pregnancy
- Considered safe to use
- Monitoring required – observe the infant for potential adverse effects (drowsiness, poor feeding, sleeping pattern changes) (*NB. Unlikely scenario in context of emergency indications)
Notes
- Ketamine is managed as a restricted medication in AV
- Emergence reactions associated with ketamine administration for analgesia in adult patients may be managed with midazolam. Consultation with the RCH is required to administer midazolam to paediatric patients
Infusion
- AAV only: Ketamine 50mg added to make 50 mL with Dextrose 5% or Normal Saline to make 1 mg/mL dilution