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Clinical References

Pharmacology

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Learning Center/Pharmacology/Ketamine

induction agent

Ketamine

Ketalar

Route: IV · IM · Intranasal
Onset: IV 30–60 seconds; IM 3–5 minutes
Duration: IV 10–20 minutes

Mechanism of action

NMDA receptor antagonist producing dissociative anesthesia and analgesia. Releases catecholamines (raises HR and BP), preserves airway reflexes and respiratory drive at usual doses, and relaxes bronchial smooth muscle.

Dosing

Adult: RSI: 1–2 mg/kg IV (4–5 mg/kg IM). Procedural sedation: 1–1.5 mg/kg IV. Analgesia: 0.1–0.3 mg/kg IV
Pediatric: Procedural sedation: 1–1.5 mg/kg IV or 4–5 mg/kg IM

Indications

Induction for rapid sequence intubation, especially in hypotension or bronchospasm
Procedural sedation and analgesia
Refractory status asthmaticus (off-label infusion)
Sub-dissociative analgesia

Contraindications

Age <3 months
Known or suspected schizophrenia
Use with caution in uncontrolled hypertension, aortic dissection, active coronary ischemia

Side effects

Emergence reactions (hallucinations, agitation)
Hypersalivation
Tachycardia and hypertension
Laryngospasm (rare)
Vomiting on recovery
Raised intraocular pressure

Monitoring parameters

SpO2 and capnography during sedation
Blood pressure and heart rate
Airway patency and secretions

Drug interactions

Additive respiratory depression with opioids and benzodiazepines
Benzodiazepines reduce emergence reactions

NBRC high-yield

Dissociative NMDA antagonist
Preserves respiratory drive and airway reflexes; bronchodilates
Raises HR and BP; emergence reactions

Clinical pearls

Bronchodilating, blood-pressure-supporting induction agent — a common choice in the asthmatic or hypotensive patient
In catecholamine-depleted shock it can still cause hypotension
Have suction ready for hypersalivation

Ketamine (Ketalar) — Respiratory Pharmacology