What is the presentation of Ketamine?
200mg in 2mL.
What is the pharmacology of Ketamine?
A rapid acting dissociative anaesthetic agent (primarily an NMDA receptor antagonist).
What are the pharmacological actions of Ketamine?
Production of a dissociative state characterised by:
- A trance-like state with eyes open but not responsive
- Nystagmus
- Profound analgesia
- Normal pharyngeal and laryngeal reflexes
- Normal or slightly enhanced skeletal muscle tone
- Occasionally a transient and minimal resp. depression
How is Ketamine metabolised and excreted?
Metabolised by the liver and excreted by the kidneys.
List the PEI’s for Ketamine.
- RSI
- Extreme traumatic pain refractory to opioid analgesia
- Extreme agitation
- CPR interfering pt
List the contraindications for Ketamine.
- Known hypersensitivity
2. Severe hypertension (SBP >180)
List the precautions for Ketamine.
- Any condition where a significant elevation of BP would be hazardous, eg:
- HTN
- CVA
- Recent AMI
- CCF - If being administered for analgesia, inject slowly over 1 min to reduce risk of respiratory depression and hypertension
List the side effects of Ketamine.
CARDIOVASCULAR
1. Increase in BP and HR
CNS
- Respiratory depression or apnoea
- Emergence rxns (nightmares, restlessness, vivid dreams, confusion, hallucinations, irrational behaviour)
- Enhanced skeletal tone
- Nausea and vomiting
OCULAR
6. Diplopia and nystagmus with slight increase in intraocular pressure
OTHER
- Lacrimation
- Local pain at injection site
- Hypersalivation
List the special notes for Ketamine.
- Emergence rxns associated with Ketamine for analgesia in the adult pt can be managed with Midazolam.
- Consultation w/ RCH is required for Midaz admin in paediatrics.
- Hypersalivation can be managed with suction or Atropine if severe.
List the onset and duration for IM Ketamine.
*Peak not listed.
O: 3 - 4mins
D: 12 - 25mins
List the onset and duration for IV Ketamine.
*Peak not listed
O: 30s
D: 10mins
