Ketalar

ketamine

(ket-a-meen) ,

Ketalar

(trade name)

Classification

Therapeutic: general anesthetics

Pregnancy Category: UK

Indications

Anesthesia for short-term diagnostic and surgical procedures.As induction before the use of other anesthetics.As a supplement to other anesthetics.Provides sedation and analgesia.

Action

Blocks afferent impulses of pain perception.

Suppresses spinal cord activity.

Affects CNS transmitter systems.

Therapeutic effects

Anesthesia with profound analgesia, minimal respiratory depression, and minimal skeletal muscle relaxation.

Pharmacokinetics

Absorption: Rapidly absorbed after IM administration.

Distribution: Rapidly distributed. Enters the CNS; crosses the placenta.

Metabolism and Excretion: Mostly metabolized by the liver. Some conversion to another active compound.

Half-life: 2.5 hr.

Time/action profile (anesthesia)

ROUTE	ONSET	PEAK	DURATION
IV	30 sec	unknown	5–10 min
IM	3–4 min	unknown	12–25 min

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Psychiatric disturbances; Hypertension; ↑ intracranial pressure; Obstetric / Lactation: Pregnancy or lactation.

Use Cautiously in: Cardiovascular disease; Procedures involving larynx, pharynx, or bronchial tree (muscle relaxants required); Gastroesophageal reflux; Hepatic dysfunction; History of alcohol abuse; Cerebral trauma; Intracerebral mass or hemorrhage; Hyperthyroidism; History of psychiatric problems; ↑ intraocular pressure; Severe eye trauma.

Adverse Reactions/Side Effects

Central nervous system

• emergence reactions (most frequent)
• ↑ intracranial pressure

Ear, Eye, Nose, Throat

• diplopia
• ↑ intraocular pressure
• nystagmus

Respiratory

• laryngospasm
• respiratory depression and apnea (rapid IV administration of large doses)

Cardiovascular

• hypertension (most frequent)
• tachycardia (most frequent)
• arrhythmias
• bradycardia
• hypotension

Gastrointestinal

• excessive salivation
• nausea
• vomiting

Genitourinary

• cystitis

Dermatologic

• erythema
• rash

Local

• pain at injection site

Musculoskeletal

• ↑ skeletal muscle tone

Interactions

Drug-Drug interaction

Use with barbiturates, hydroxyzine and opioid analgesics may result in prolonged recovery time.Use with halothane may result in ↓ BP, cardiac output, and heart rate.Use with tubocurarine or nondepolarizing neuromuscular blocking agents may result in prolonged respiratory depression.Concurrent use with thyroidhormone ↑ risk of tachycardia and hypertension.Concurrent administration with diazepam may ↓ incidence of emergence reaction.Concurrent administration with atropine may ↑ incidence of unpleasant dreams.

Route/Dosage

General Anesthesia

Intravenous (Adults) Induction—1–2 mg/kg (range 1–4.5 mg/kg)–2 mg produces 5–10 min of surgical anesthesia or 1–2 mg/kg as a single injection or infused at 0.5 mg/min. May be used with concurrent diazepam. Maintenance—Increments of ½ to the full induction dose may be repeated as needed. If given with concurrent diazepam, an infusion of 0.1–0.5 mg/min may be used, augmented by 2–5 mg doses of diazepam.

Intravenous (Children) 0.5–2 mg/kg, use smaller doses (0.5–1 mg/kg)for minor procedures.

Intramuscular (Adults) 3–8 mg/kg (10 mg/kg produces 12–25 min of surgical anesthesia).

Intramuscular (Children) 3–7 mg/kg.

Oral (Children) 6–10 mg/kg for 1 dose (mix in cola or other beverage) 30 min prior to procedure.

Sedation/Analgesia (Unlabeled)

Intravenous (Adults) 200–750 mcg (0.2–0.75 mg)/kg over 2–3 min initially, followed by 5–20 mcg (0.005–0.02 mg)/kg/min as an infusion.

Intravenous (Children) 5–20 mcg/kg/min.

Intramuscular (Adults) 2–4 mg/kg initially, then 5–20 mcg (0.005–0.02 mg)/kg/min as an IV infusion.

Availability (generic available)

Injection: 10 mg/mL, 50 mg/mL, 100 mg/mL

Nursing implications

Nursing assessment

• Assess level of consciousness frequently throughout therapy. Ketamine produces a dissociative state. The patient does not appear to be asleep and experiences a feeling of dissociation from the environment.
• Monitor BP, ECG, and respiratory status frequently throughout therapy. May cause hypertension and tachycardia. May cause increased CSF pressure and increased intraocular pressure.
Respiratory depression or apnea may be treated with mechanical ventilation or analeptics.

Potential Nursing Diagnoses

Risk for injury (Side Effects)
Disturbed sensory perception (Adverse Reactions)

Implementation

• Do not confuse Ketalar (ketamine) with ketorolac.
• Administer on an empty stomach to prevent vomiting and aspiration.
  • May be administered concurrently with a drying agent (atropine, scopolamine); ketamine increases salivary and tracheobronchial mucous gland secretions. Atropine may also increase the incidence of unpleasant dreams.
  • Patients may experience a state of confusion (emergence delirium) during recovery from ketamine. Administering a benzodiazepine and minimizing verbal, tactile, and visual stimulation may prevent emergence delirium. Severe emergence delirium may be treated with short- or ultra-short-acting barbiturates.
• Oral: Use 100 mg/mL IV solution and mix appropriate dose in 0.2–0.3 mL/kg of cola or other beverage.

• Intravenous Administration

• Diluent: Dilute 100 mg/mL concentration with equal parts of sterile water for injection, 0.9% NaCl, or D5W. Concentration: Maximum concentration for slow IV push 50 mg/mL.
• Rate: Administer over 60 sec unless a rapid-sequence induction technique is indicated. More rapid administration may cause respiratory depression, apnea, and hypertension. Do not exceed 0.5 mg/kg/min.
• Continuous Infusion: Diluent: Dilute 10 mL of 50 mg/mL concentration or 5 mL of 100 mg/mL concentration with 500 mL of 0.9% NaCl or D5W and mix well. Concentration: 1 mg/mL. Dilution with 250 mL may be used if fluid restriction is needed, for a maximum concentration of 2 mg/mL.
• Rate: Administer at a rate of 0.5 mg/kg/min for induction. Maintenance infusion may be administered at a rate of 1–2 mg/min or 0.1–0.5 mg/min given concurrently with diazepam. Dose must be titrated according to individual patient requirements. Tonic-clonic movements during anesthesia do not indicate the need for more ketamine.
• Y-Site Compatibility: albumin, amikacin, amiodarone, atropine, caffeine citrate, calcium gluconate, cefazolin, cefepime, cefotaxime, ceftazidime, cefuroxime, chlorpromazine, clindamycin, clonidine, digoxin, diphenhydramine, dobutamine, dopamine, epinephrine, gentamicin, haloperidol, hydrocortisone, magnesium sulfate, meperidine, metoclopramide, metronidazole, midazolam, milrinone, morphine, multivitamins, naloxone, oxytocin, pancuronium, penicillin G, piperacillin/tazobactam, potassium chloride, promethazine, propofol, ranitidine, sufentanil, tobramycin, vancomicin
• Y-Site Incompatibility: acyclovir, ampicillin, furosemide, heparin, insulin, meropenem, phenytoin, potassium phosphates, sodium bicarbonate, trimethoprim/sulfamethoxazole

Patient/Family Teaching

• Psychomotor impairment may last for 24 hr after anesthesia. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient to avoid alcohol or other CNS depressants for 24 hr after anesthesia.

Evaluation/Desired Outcomes

• Sense of dissociation and general anesthesia without muscle relaxation.

Ketalar

Ketamine, see there.

Ketalar

A brand name for KETAMINE.