KETAMINE

Indications & Dose:

It is used mainly for paediatric anaesthesia, particularly when repeated administration are required. Recovery is relatively slow. In subanaesthetic dose to provide analgesia for painful procedure of short duration e.g. marrow sampling,  dressing of burns. For induction of anaesthesia prior to inhalational anaesthetics, induction and maintenance of anaesthesia for short-lasting diagnostic and surgical procedures e.g. dental procedures. It is of value in children who require repeated anaesthetics. With diazepam it is used in angiography, trauma

By intramuscular injection, short procedures, initially 6.5-13mg/kg (10mg/kg usually produces 12-25 minutes of surgical anaesthesia). Diagnostic manoeuvres and procedures are involving intense pain, initially 4mg/kg.

By intravenous injection over at least 60 seconds, short procedures, initially 1-4.5mg/kg (2mg/kg) usually produces 5-10 minutes of surgical anaesthesia)

By intravenous infusion of a solution containing 1mg/mL, longer procedures, induction, total dose of 0.5-2mg/kg; maintenance (using micro drip infusion), 10-45 micrograms/kg/minute, rate adjusted according to response.

surgery, cardiac catheterization. 

Contraindications:

Pregnancy, hypertension and is best avoided in those prone to hallucinations. Avoid in elderly patients. Cerebral trauma, glaucoma, schizophrenia, psychoses, chronic alcohol intoxication, history of CVA.

ABSOLUTE CONTRAINDICATIONS: Airway obstruction (inhalation anasthetic used where airway obstruction is indicated. Raised intracranial pressure

Side Effects:

Arrhythmia, tachy-cardia, hallucination, respiratory depression, diplopia, hypotension, vivid dreams, nystagmus, nausea, anorexia, vomiting,  clonic and tonic movements.

Cautions:

Precautions:

Cardio vascular disease or hypertension, ischaemic heart disease or severe cardiac decompensation. Repeated administration because of prolong recovery period. Visceral stimulation Out patient anasthesia especially in adult patients. To be given by trained anaesthetist. Pulse and BP to be monitored. Over dosage or rapid injection may result in respiratory depression.

Breast-feeding: Use with caution.

Old age: May be used. 

Interaction:

Drug

Barbiturates or  narcotics: Prolonged recovery time may occur.

Halothane: Blocks cardiovascular stimulatory effects of ketamine leading to decreased cardiac output, blood pressure and pulse rate.

Tubocurarine and non depolarizing muscle relaxants: Increased neuromuscular effects, leading to prolonged resp. depression.

Thyroid hormones: Concurrent use may produce hypertension and tachycardia.

Aminophylline: Reduces seizure threshold.

Alcohol: Resistance to ketamine anaesthesia; exaggerated psychosomatic effects during recovery from anaesthesia.

Oxytocin, ergometrine: Potentiate cardio vascular adverse effects.

Benzodiazepines: Reduced incidence of and severity of psychomimetics and cardio vascular responses.

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: