Ketamine

From IDWiki

Background

  • Phencyclidine (PCP) derivative
  • Inhibits NMDA (N-methyl-d-aspartate) receptors
  • Dose-dependent effects: low doses are primarily analgesic, while high doses cause dissociative anesthesia
    • When used for management of acute pain, can be opioid-sparing

Dosing

  • Analgesia1
    • Intermittent: start at 0.1 mg/kg IV q4h, and titrate (max 0.35 mg/kg)
    • Continuous infusion: start at 0.1 mg/kg/h IV infusion, and titrate (max 0.25 mg/kg/h)
  • Dissociative anesthesia: ≥1 mg/kg

Hepatic Dosing

  • Avoid in liver dysfunction

Safety

  • Avoid in patients with psychosis, severe cardiovascular disease, or liver dysfunction

Adverse Effects

  • Primarily dose-dependent, with nausea, vomiting, vivid dreams, hallucinations, and dissociation seen at high doses

Pregnancy

  • Unclear safety in pregnancy

References

  1. ^ silverstein2021ke