MASSACHUSETTS GENERAL HOSPITAL
Department of Pharmacy
Department of Nursing
Critical Care
Generic Name: Ketamine
Brand Name: Ketalar®
Action: Ketamine is a nonbarbiturate anesthetic/analgesic that produces
a cataleptic-like state in which the patient is dissociated from the surrounding
environment by direct action on the cortex and limbic system
Indications:
- Analgesia and Sedation in Special Care Units Only
- Conscious Sedation in Approved Areas
Restrictions:
- ICU use only
- Areas approved for conscious sedation
Administration Guidelines:
Usual Dosage Range and Route:
Analgesia and Sedation in Special Care Units Only
LOADING DOSE: 0.2-1 mg/kg IVP no faster than 60 seconds to avoid respiratory
depression and enhanced vasopressor response
MAINTENANCE: 5-30 mcg/kg/min titrated to patient response
Conscious Sedation in Approved Areas
IV: 2 mg/kg Atropine (0.01 mg/kg IV) or glycopyrrolate (0.01 mg/kg)
should be administered to prevent hypersalivation.
IM: a single 4 mg/kg Ketamine (concentration 100 mg/ml to limit pain
on injection) with atropine 0.02 mg/kg in the same syringe.
IV: supplement 1 mg/kg Ketamine as needed.
Supplemental doses of IM ketamine are not approved for any patient.
Standard Concentration:
MICROINFUSION: 500mg/50mL (10mg/mL) Syringe
Special Considerations:
- Load should not be given faster than 60 second to avoid respiratory depression
and pressor response
- Emergence reactions:
- Manifestations vary in severity between dream-like states, vivid imagery,
hallucinations and emergence delirium
- Administering IM and/or using a lower dose of ketamine in conjunction
with a benzodiazepine (or barbiturate??) may reduce the incidence
Precautions and Side Effects:
- Conditions where a significant elevation of blood pressure is hazardous
(e.g., patients with poorly controlled hypertension, aneurysms, acute right-
or left-sided heart failure, angina, cerebral trauma, recent myocardial infarction)
- Neurotic traits or psychiatric illness (schizophrenia, acute psychosis)
- Alcohol intoxication or a history of alcohol abuse
- Acute intermittent porphyria
- Seizures
- Glaucoma or elevated intraocular pressure
- Hyperthyroidism or patients receiving thyroid replacement (increased
risk of hypertension, tachycardia)
- Pulmonary or upper respiratory infection (ketamine sensitizes the gag
reflex, potentially causing laryngospasm)
- Intracranial mass lesions, presence of head injury, globe injuries, or
hydrocephalus
Rev. 12/02