Parenteral Manual

Ketamine HCl

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
KETALAR®
Classification: 
General anesthetic
Original Date: 
August 2005
Revised Date: 
November 2014
Indications: 
  • Induction of anesthesia prior to administration of other anesthetics
  • To supplement low potency agent such as nitrous oxide
  • Sole anesthetic agent for recommended diagnostic and surgical procedures
  • Analgesia for burn patients
  • Subanesthetic doses for the management of acute and chronic pain
    LOW DOSE KETAMINE INFUSIONS -RESTRICTED TO PATIENTS MANAGED BY ACUTE PAIN SERVICE (APS), PALLIATIVE CARE and the PEDIATRIC INTENSIVISTS for the IN-PATIENT AREAS
Reconstitution and Stability: 
  • Available as 10 and 50 mg/mL vials
  • Stable at room temperature. Protect from light
  • Solution is colourless to slightly yellow, darkening upon exposure to light does not affect potency.
Compatibility: 

- Solutions Compatible: D5W, 0.9% NaCl

- Additives/Above Cassette Compatible: morphine

- Y-site Compatible: hydromorphone, midazolam

- Incompatible: barbiturates, diazepam

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM YES
IV Direct

YES
Usual dilution: < 50 mg/mL
Infusion time: > 60 seconds
Infusion rate: do not exceed 0.5 mg/kg/minute
IV Intermittent Infusion YES
Usual dilution: 1 mg/mL
IV Continuous Infusion YES
Usual dilution: 1 mg/mL
Standard Concentrations in ER/OR/PICU:  1 mg/mL, 5 mg/mL

Click here to access SDC Drug Infusion Sheet

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

 

NOTE:  1000 mcg = 1 mg

Pediatric:                      

  • IM: 3-7 mg/kg
  • IV: 0.5-2 mg/kg, use smaller doses (0.5-1 mg/kg) for sedation for minor procedures
  • IV infusion (sedation):  300 - 1200 mcg/kg/hour ; start low and titrate to effect
  • Low Dose IV infusion (pain) :  100 - 300 mcg/kg/hour, MAX 1500 mcg/kg/hour

Adolescent/Adult:       

  • IM: 3-8 mg/kg          
  • IV: 1-4.5 mg/kg

Maintenance (Pediatric/adult):

  • 1/3 to 1/2 of the induction dose as required

- IM produces anesthesia in 3-4 minutes lasting for 12-25 minutes
- IV produces anesthesia within 30 seconds and lasting 5-10 minute

 

Potential hazards of parenteral administration: 
  • Rapid IV administration may produce respiratory depression and enhance pressor response       
  • Hallucinations, confusion, floating sensations, vivid dreams and insomnia
  • Hypertension or hypotension
  • Tachycardia, laryngospasm, increased intracranial pressure (ICP)
  • Temporary elevation of pulse rate
  • Nausea and vomiting (minimal), increased  salivation
  • Blurred vision and nystagmus during recovery

 

Notes: 

Contraindicated - elevated intracranial pressure, history of cerebrovascular accident, severe hypertension, severe cardiac decompensation, psychotic disorders

  • Safe use in pregnancy not established
  • Consider dose reductions in patients with hepatic impairment

 

NURSING MONITORING GUIDELINES:

  • Equipment  for assisted respiration and administration of 02 necessary -Oxyen saturation alarm setting MUST NOT by turned off or volume turned down.  Saturation monitoring can be suspended to allow for patient ambulation (with assistance)
  • Utilize a locked pump for delivery of a continuous infusion (in-patient areas)
  • Tubing without in-line injection ports must be utilized & connected as close to the IV site as possible
     

MONITOR:

prior  first dose- Obtain weight, and a baseline assessment including sedation score ,HR,RR,BP, oxygen saturation and pain assessment (intensity/location)

ongoing monitoring- Q1H  -HR,RR (includes rate/depth), pain score and sedation score x 4 hours
                           then- Q2H x 4 hours (using validated pain tool for pain score)
                           then- Q4h until the infusion is discontinued
with increase in infusion rate -HR,RR, oxygen saturation, pain score and sedation  score Q1H x 6 hours then resume previous monitoring

 

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