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All about: Ketamine Hydrochloride

Big Image Pronouncation: (KEET-uh-MEEN HIGH-droe-KLOR-ide)
Class: General anesthetic

Trade Names:
- Injection 10 mg/mL
- Injection 50 mg/mL
- Injection 100 mg/mL

Mechanism of Action


Produces rapid-acting anesthetic state with profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and, occasionally, transient and minimal respiratory depression.



Ketamine is rapidly absorbed. Mean C max is 0.75 mcg/mL. T max is 1 h.


Distribution t ½ is approximately 10 to 15 min. Ketamine is rapidly distributed into body tissues, with high concentrations in body fat, liver, lungs, and brain. Protein binding with this drug is not significant.


Undergoes N-demethylation and hydroxylation of cyclohexone ring. The N-demethylated metabolite is less than 1/ 6 as potent and the demethyl cyclohexone derivative is less than 1/ 10 as potent as the drug.


Elimination t ½ is 2.5 h. Approximately 91% is excreted in urine and 3% in feces.

Indications and Usage

Diagnostic and surgical procedures that do not require skeletal muscle relaxation; induction of anesthesia; supplementation of low-potency agents, such as nitrous oxide.


Patients in whom significant BP elevation would be a serious hazard; hypersensitivity to the drug.

Dosage and Administration

Adults and Children: induction of anesthesia

IV Initial: 1 to 4.5 mg/kg via slow infusion (over 60 sec); usual dose for 5 to 10 min anesthesia: 2 mg/kg. Maintenance: One-half to full induction dose, repeated as needed. Alternatively IV 0.1 to 0.5 mg/min infusion, augmented with diazepam IV 2 to 5 mg.

IM Initial: 6.5 to 13 mg/kg. Maintenance: One-half to full induction dose, repeated as needed.


Store vials at controlled room temperature (59° to 86°F). Protect from light.

Drug Interactions


Decreased cardiac output, BP, and pulse.

Tubocurarine and other nondepolarizing muscle relaxants

Increased neuromuscular effects, resulting in prolonged respiratory depression.


Ketamine is physically incompatible with diazepam and barbiturates.

Laboratory Test Interactions

None well documented.

Adverse Reactions


Hypertension; tachycardia; hypotension; bradycardia; arrhythmia.


Increased ICP. Emergence reaction: Vivid imagery; hallucinations; delirium; confusion; excitement; irrational behavior.


Transient erythema; morbilliform rash.


Diplopia; nystagmus; increased intraocular pressure.


Anorexia; nausea; vomiting; hypersalivation.


Respiratory stimulation; severe respiratory depression; apnea after rapid injection; laryngospasm; other airway obstruction.



Emergence reactions

Emergence reactions occur in approximately 12% of patients. The incidence is least in young (younger than 15 yr of age) and elderly (older than 65 yr of age) patients. Also less frequent with IM use.

Psychological manifestations

Severity varies between pleasant dream-like states, vivid imagery, hallucinations and emergence delirium sometimes accompanied by confusion, excitement and irrational behavior. The duration is ordinarily a few hours; however, recurrences have been seen up to 24 h postoperatively. No residual psychological effects are known. The incidence may be reduced by using lower dosages with IV diazepam. These reactions may be reduced if verbal, tactile and visual patient stimulation is minimized during recovery. This does not preclude monitoring vital signs.


To terminate a severe emergence reaction, a small hypnotic dose of a short-acting or ultrashort-acting barbiturate may be required. When used on an outpatient basis, do not release patient until recovery from anesthesia is complete. Patients should be accompanied by an adult.


Category B .




Safety and efficacy in children younger than 16 yr of age have not been established.


Use with caution in chronic alcoholics and acutely alcohol intoxicated patients.

Cerebrospinal fluid pressure

Cerebrospinal fluid pressure increase has been reported following administration.

Hypertension or cardiac decompensation

In patients with these conditions, monitor function continuously during procedure.

Preoperative preparation

Give atropine, scopolamine, or another drying agent at an appropriate interval prior to induction.

Respiratory effects

May occur with overdosage or too rapid a rate of administration.

Respiratory surgery/diagnostic procedures

Do not use in surgery or diagnostic procedures of the pharynx, larynx, or bronchial tree. Do not administer ketamine alone because pharyngeal and laryngeal reflexes are usually active. Muscle relaxants, with proper attention to respiration, may be required.

Visceral pain

In surgical procedures involving visceral pain pathways, supplement with an agent that obtunds visceral pain.



Respiratory depression.

Patient Information

  • Advise patient that neurologic effects may persist for 24 h after anesthesia. Advise patient to use caution during this period while driving or performing other tasks requiring mental alertness.

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