Ketamine
CLINICAL USE
Anaesthetic agent, analgesic
DOSE IN NORMAL RENAL FUNCTION
All doses are expressed as the base: 1.15 mg ketamine hydrochloride ≡1 mg of baseAnaesthesia: IM Short procedures: initially 6.5–13 mg/ —kg (10 mg/kg usually gives 12–25 minutes of surgical anaesthesia)Painful diagnostic manoeuvres: initially —4 mg/kgIV Injection: Initially 1–4.5 mg/kg over at least —60 seconds (2 mg/kg usually gives 5–10 minutes of surgical anaesthesia)IV Infusion: Induction total dose of —0.5–2 mg/kg; maintenance 10–45 mcg/kg/min; adjust rate according to response if infusion requiredAnalgesia: IM: 1.5–2 mg/kg —IV Infusion: 2–3 mg/kg or infusion rate —5–10 mg/hour of a solution of 5 mg/mL
PHARMACOKINETICS
DOSE IN RENAL IMPAIRMENT
GFR (mL/MIN)
DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES
IMPORTANT DRUG INTERACTIONS
Potentially hazardous interactions with other drugsAdrenergic-neurone blockers: enhanced hypotensive effectAntihypertensives: enhanced hypotensive effect
ADMINISTRATION
Reconstition
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Route
IV bolus, IV Infusion, IM
Rate of Administration
Injection: over at least 60 seconds Infusion: Depends on clinical indication
Comments
For infusion add to glucose 5% or sodium chloride 0.9%, dilute to 1 mg/mL. In the USA can dilute to 2 mg/mL in fluid restricted patients (Dollery)Incompatible with diazepam and barbituratesUse infusion solutions within 24 hours 100 mg/mL strength must be diluted with an equal volume of water for injection, sodium chloride 0.9% or glucose 5% before useMinimum volume 50 mg/mL (undiluted). (UK Critical Care Group, Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006)