Ketamine

- 500 mg/10 ml, 1000 mg/10 ml, 200 mg/20 ml vials (IV, IM)

Executive Summary

(December 1, 2023)

Ketamine, a dissociative and analgesic agent, has seen a notable surge in its usage within the ED over the past decade. It is employed as an induction agent for endotracheal intubation, procedural analgosedation, management of agitation, and acute pain relief (5, 18, 19, 22, 32, 33).


Adult dose for endotracheal intubation induction (35, 39)

1.5-2 mg/kg IV.


Adult dose for procedural sedation and analgesia (3, 21, 40)

0.3-1 mg/kg IV.

Adult dose

Adult dose for endotracheal intubation induction (35, 39)

1.5-2 mg/kg IV.


Comments:


Adult dose for procedural sedation and analgesia (3, 21, 39)

0.3-1 mg/kg IV.


Comments


Adult dose for severe agitation (dangerous or violent)(32)

4 mg/kg IM.


Comments:

Indications

Approved for adults and pediatric patients of >16 years or older.


Ketamine for endotracheal intubation in the ED

Overview


Rapid sequence intubation


Delayed sequence intubation (DSI)


The ketamine-only intubation technique will be discussed in a future update. Meanwhile, it can be reviewed in the following references: Merelman et al. 2019 (27), Driver et al. 2021 (34) and the 6th edition of the Walls Manual of Emergency Airway Management (35).

Ketamine for the agitated patient



Ketamine for procedural sedation and analgesia








Mechanism of action and pharmacology

Mechanism of action (31)



Pharmacology


Cautions









Laryngospasm risk and management




Pregnancy and lactation

Pregnancy risk classification


Lactation (42)

References

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EMDrugs Team