.
Ketamine
Drug
 
Aliases:
Ketalar
Ketaset
Ketanest
Special K

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Ketamine is a rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression.
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Rapid onset phencyclidine derivative dissociative anaesthetic and analgesic used for induction and maintenance of anaesthesia as well as analgesia. Main points of interest are its CVS and respiratory stimulation and its psychotropic side effects.

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Analgesia - Ketamine is particularly useful in patients where escalating doses of opioid are necessary or when an opioid sparing effect is desired. Most patients get mild dysphoria with boluses, however most cope with this if warned beforehand. Ketamine is not recommended for patients <2 years old because of concerns with postulated brain development effects. (Murine lab data) Most patients achieve satisfactory analgesia with 100 - 200 microgram/kg/hr

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Dose for a Ketamine plus Midazolam combination premedication is Ketamine 5mg/kg, and midazolam 0.2mg/kg.
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Ketamine infusion chart at the Royal Children's Hospital Melbourne www.rch.org.au/emplibrary...

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Onset of action :
(General anaesthetic dose)
IV 2mg/kg dose is 30-60secs,
IM 10-15mg/kg is 3 mins

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M.O.A : NMDA antagonist, mu opiod agonist (S-enantiomer)
Special effects
CVS : Stimulation (Tachycardia, Hypertension, increased myocardial oxygen demand), increase pulm vasc-resistance
Resp :Stimulation (Tachypnoea, dec tidal volume, hypersecretion, maintenance of airway reflexes (layryngospasm can occur), maintains CO2 sensivity., bronchodilation
CNS : Increase CBF, CMRO2, ICP, Intense analgesia

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