Ketamine

DEA Class;  Rx

Common Brand Names; Ketalar

Hypersensitivity

Conditions in which an increase in blood pressure would be hazardous

• Emergence rxns
• HTN
• Increased cardiac output
• Increased ICP
• Tachycardia
• Tonic-clonic movements
• Visual hallucinations
• Vivid dreams
• Bradycardia
• Diplopia
• Hypotension
• Increased IOP
• Injection-site pain
• Nystagmus
• Anaphylaxis
• Cardiac arrhythmia
• Depressed cough reflex
• Fasciculations
• Hypersalivation
• Increased IOP
• Increased metabolic rate
• Hypertonia
• Laryngospasm
• Respiratory depression or apnea with large doses or rapid infusions

Increases ICP (head raising may alleviate); causes hypersalivation (may be controlled with atropine/glycopyrrolate)

Not for use alone in surgery or diagnostic procedures of the pharynx, or bronchial tree, mechanical stimulation of the pharynx, larynx, or bronchial tree; avoid mechanical stimulation of the pharynx if ketamine used alone

May cause CNS depression; use caution when operating heavy machinery; do not engage in hazardous activities or operate hazardous machinery for at least 24 hr after anesthesia

May cause dependence and tolerance with prolonged use; discontinuation of long term use has been associated with a withdrawal syndrome with psychotic features

Treat CNS abnormalities, CNS masses, or hydrocephalus as a relative contraindication, due to increased intracranial pressure produced by ketamine

Therapy may increase intraocular pressure, use with caution in patients with increased intraocular pressure; avoid use in patients with eye injury or other ophthalmic disorder

Glaucoma or acute globe injury may be considered a relative contraindication

Therapy may enhance sympathomimetic effect; use caution in patients with porphyria or a thyroid disorder; may consider porphyria and thyroid disorder or thyroid therapy a relative contraindication

Use caution in patients with coronary artery disease, catecholamine depletion, hypertension and tachycardia; monitor cardiac function continuously in patients with increased blood pressure, heart rate, and cardiac output, thereby increasing myocardial oxygen demand

Use caution in patients with cerebrospinal fluid pressure elevation; increase in cerebrospinal fluid pressure may be associated with use

Use with caution in chronic alcoholic patients or acutely intoxicated

Use requires patient monitoring, to be administered only by experienced personnel who are not actively engaged in the procedure or surgery; in nonintubated and/or nonmechanically ventilated patients, appropriate equipment and qualified personnel should be immediately available to use appropriate equipment for rapid institution of respiratory and/or cardiovascular support

Too rapid administration will cause respiratory depression

There are no adequate and well-controlled studies performed in pregnant women; in animal reproduction studies in rats developmental delays (hypoplasia of skeletal tissues) were noted at 0.3 times the human intramuscular dose of 10 mg/kg

Not known if excreted in breast milk; effect on nursing infant unknown