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1 rhage; Hyperthyroidism; History of psychiatric problems;qintraocular pressure; Se-
vere eye trauma.
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ketamine (ket-a-meen) Adverse Reactions/Side Effects
Ketalar CNS: emergence reactions,qintracranial pressure. EENT: diplopia,qintraocular
Classification pressure, nystagmus. Resp: laryngospasm, respiratory depression and apnea (rapid
Therapeutic: general anesthetics IV administration of large doses). CV: hypertension, tachycardia, arrhythmias,
Pregnancy Category UK bradycardia, hypotension. GI: excessive salivation, nausea, vomiting. GU: cystitis.
Derm: erythema, rash. Local: pain at injection site. MS:qskeletal muscle tone.
Indications Interactions
Anesthesia for short-term diagnostic and surgical procedures. As induction before Drug-Drug: Use with barbiturates, hydroxyzine and opioid analgesics may
the use of other anesthetics. As a supplement to other anesthetics. Unlabeled Use: result in prolonged recovery time. Use with halothane may result inpBP, cardiac
Provides sedation and analgesia. output, and heart rate. Use with tubocurarine or nondepolarizing neuromus-
cular blocking agents may result in prolonged respiratory depression. Concurrent
Action use with thyroid hormoneqrisk of tachycardia and hypertension. Concurrent ad-
Blocks afferent impulses of pain perception. Suppresses spinal cord activity. Affects
ministration with diazepam maypincidence of emergence reaction. Concurrent ad-
CNS transmitter systems. Therapeutic Effects: Anesthesia with profound analge-
ministration with atropine mayqincidence of unpleasant dreams.
sia, minimal respiratory depression, and minimal skeletal muscle relaxation.
Pharmacokinetics Route/Dosage
Absorption: Rapidly absorbed after IM administration. General Anesthesia
Distribution: Rapidly distributed. Enters the CNS; crosses the placenta. IV (Adults): Induction— 1– 2 mg/kg (range 1– 4.5 mg/kg)– 2 mg produces 5–
Metabolism and Excretion: Mostly metabolized by the liver. Some conversion 10 min of surgical anesthesia or 1– 2 mg/kg as a single injection or infused at 0.5 mg/
to another active compound. min. May be used with concurrent diazepam. Maintenance— Increments of 1⁄2 to
Half-life: 2.5 hr. the full induction dose may be repeated as needed. If given with concurrent diaze-
TIME/ACTION PROFILE (anesthesia) pam, an infusion of 0.1– 0.5 mg/min may be used, augmented by 2– 5 mg doses of
ROUTE ONSET PEAK DURATION
diazepam.
IV (Children): 0.5– 2 mg/kg, use smaller doses (0.5– 1 mg/kg)for minor proce-
IV 30 sec unknown 5–10 min dures.
IM 3–4 min unknown 12–25 min IM (Adults): 3– 8 mg/kg (10 mg/kg produces 12– 25 min of surgical anesthesia).
IM (Children): 3– 7 mg/kg.
Contraindications/Precautions PO (Children): 6– 10 mg/kg for 1 dose (mix in cola or other beverage) 30 min
Contraindicated in: Hypersensitivity; Psychiatric disturbances; Hypertension;q prior to procedure.
intracranial pressure; OB, Lactation: Pregnancy or lactation.
Use Cautiously in: Cardiovascular disease; Procedures involving larynx, pharynx, Sedation/Analgesia (Unlabeled)
or bronchial tree (muscle relaxants required); Gastroesophageal reflux; Hepatic dys- IV (Adults): 200– 750 mcg (0.2– 0.75 mg)/kg over 2– 3 min initially, followed by
function; History of alcohol abuse; Cerebral trauma; Intracerebral mass or hemor- 5– 20 mcg (0.005– 0.02 mg)/kg/min as an infusion.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/ketamine 02/14/2014 03:50PM Plate # 0-Composite pg 2 # 2
2 sequence induction technique is indicated. More rapid administration may cause
respiratory depression, apnea, and hypertension. Do not exceed 0.5 mg/kg/min.
IV (Children): 5– 20 mcg/kg/min. ● Continuous Infusion: Diluent: Dilute 10 mL of 50 mg/mL concentration or 5 PDF Page #2
IM (Adults): 2– 4 mg/kg initially, then 5– 20 mcg (0.005– 0.02 mg)/kg/min as an mL of 100 mg/mL concentration with 500 mL of 0.9% NaCl or D5W and mix well.
IV infusion. Concentration: 1 mg/mL. Dilution with 250 mL may be used if fluid restriction
is needed, for a maximum concentration of 2 mg/mL. Rate: Administer at a rate
NURSING IMPLICATIONS of 0.5 mg/kg/min for induction. Maintenance infusion may be administered at a
Assessment rate of 1– 2 mg/min or 0.1– 0.5 mg/min given concurrently with diazepam. Dose
● Assess level of consciousness frequently throughout therapy. Ketamine produces a must be titrated according to individual patient requirements. Tonic-clonic move-
dissociative state. The patient does not appear to be asleep and experiences a feel- ments during anesthesia do not indicate the need for more ketamine.
ing of dissociation from the environment. ● Y-Site Compatibility: albumin, amikacin, amiodarone, atropine, caffeine cit-
● Monitor BP, ECG, and respiratory status frequently throughout therapy. May cause rate, calcium gluconate, cefazolin, cefepime, cefotaxime, ceftazidime, cefurox-
hypertension and tachycardia. May cause increased CSF pressure and increased ime, chlorpromazine, clindamycin, clonidine, digoxin, diphenhydramine, dobu-
intraocular pressure. tamine, dopamine, epinephrine, gentamicin, haloperidol, hydrocortisone,
● Toxicity and Overdose: Respiratory depression or apnea may be treated with magnesium sulfate, meperidine, metoclopramide, metronidazole, midazolam,
mechanical ventilation or analeptics. milrinone, morphine, multivitamins, naloxone, oxytocin, pancuronium, penicillin
Potential Nursing Diagnoses G, piperacillin/tazobactam, potassium chloride, promethazine, propofol, raniti-
Risk for injury (Side Effects) dine, sufentanil, tobramycin, vancomicin.
Disturbed sensory perception (Adverse Reactions) ● Y-Site Incompatibility: acyclovir, ampicillin, furosemide, heparin, insulin,
meropenem, phenytoin, potassium phosphates, sodium bicarbonate, trimetho-
Implementation prim/sulfamethoxazole.
● Do not confuse Ketalar (ketamine) with ketorolac.
● Administer on an empty stomach to prevent vomiting and aspiration. Patient/Family Teaching
● May be administered concurrently with a drying agent (atropine, scopolamine); ● Psychomotor impairment may last for 24 hr after anesthesia. Caution patient to
ketamine increases salivary and tracheobronchial mucous gland secretions. Atro- avoid driving or other activities requiring alertness until response to medication is
pine may also increase the incidence of unpleasant dreams. known.
● Patients may experience a state of confusion (emergence delirium) during recov- ● Advise patient to avoid alcohol or other CNS depressants for 24 hr after anesthesia.
ery from ketamine. Administering a benzodiazepine and minimizing verbal, tac-
tile, and visual stimulation may prevent emergence delirium. Severe emergence
Evaluation/Desired Outcomes
● Sense of dissociation and general anesthesia without muscle relaxation.
delirium may be treated with short- or ultra-short-acting barbiturates.
● PO: Use 100 mg/mL IV solution and mix appropriate dose in 0.2– 0.3 mL/kg of Why was this drug prescribed for your patient?
cola or other beverage.
IV Administration
● Direct IV: Diluent: Dilute 100 mg/mL concentration with equal parts of sterile
water for injection, 0.9% NaCl, or D5W. Concentration: Maximum concentra-
tion for slow IV push 50 mg/mL. Rate: Administer over 60 sec unless a rapid-
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