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KETAMINE is a brand name for Ketamine. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Ketamine is indicated in children and in adults Ketamine is recommended: As an anaesthetic agent for diagnostic and surgical procedures. When used by intravenous or intramuscular injection, Ketamine is best suited for short procedures. With additional doses, or by intravenous infusion, Ketamine can be used for longer…
Verbatim from this product's MHRA label. Tap a section to expand.
For intravenous infusion, intravenous injection or intramuscular injection.
NOTE:
All doses are given in terms of ketamine base Adults, elderly (over 65 years) and children: For surgery in elderly patients ketamine has been shown to be suitable either alone or supplemented with other anaesthetic agents. Preoperative preparations Ketamine has been safely used alone when the stomach was not empty.
However, since the need for supplemental agents and muscle relaxants cannot be predicted, when preparing for elective surgery it is advisable that nothing be given by mouth for at least six hours prior to anaesthesia. g atropine, hyoscine or glycopyrolate) or another drying agent should be given at an appropriate interval prior to induction to reduce ketamine-induced hypersalivation.
Midazolam, diazepam, lorazepam, or flunitrazepam used as a premedicant or as an adjunct to ketamine, have been effective in reducing the incidence of emergence reactions. Onset and duration As with other general anaesthetic agents, the individual response to Ketamine is somewhat varied depending on the dose, route of administration, age of patient, and concomitant use of other agents, so that dosage recommendation cannot be absolutely fixed.
The dose should be titrated against the patient’s requirements. Because of rapid induction following intravenous injection, the patient should be in a supported position during administration. An intravenous dose of 2 mg/kg of bodyweight usually produces surgical anaesthesia within 30 seconds after injection and the anaesthetic effect usually lasts 5 to 10 minutes.
An intramuscular dose of 10 mg/kg of bodyweight usually produces surgical anaesthesia within 3 to 4 minutes following injection and the anaesthetic effect usually lasts 12 to 25 minutes. Return to consciousness is gradual. A. Ketamine as the sole anaesthetic agent Intravenous Infusion The use of Ketamine by continuous infusion enables the dose to be titrated more closely, thereby reducing the amount of drug administered compared with intermittent administration.
This results in a shorter recovery time and better stability of vital signs. 9% is suitable for administration by infusion. 5 – 2 mg/kg as total induction dose. Maintenance of anaesthesia Anaesthesia may be maintained using a microdrip infusion of 10 – 45 microgram/kg/min (approximately 1 – 3 mg/min).
). 1. - In patients with eclampsia or pre-eclampsia. 4 Special warnings and precautions for use To be used only in hospitals by or under the supervision of experienced medically qualified anaesthetists except under emergency conditions.
As with any general anaesthetic agent, resuscitative equipment should be available and ready for use. Respiratory depression may occur with overdosage of Ketamine, in which case supportive ventilation should be employed. Mechanical support of respiration is preferred to the administration of analeptics.
The intravenous dose should be administered over a period of 60 seconds. More rapid administration may result in transient respiratory depression or apnoea and enhanced pressor response. Because pharyngeal and laryngeal reflexes usually remain active, mechanical stimulation of the pharynx should be avoided unless muscle relaxants, with proper attention to respiration, are used.
Although aspiration of contrast medium has been reported during Ketamine anaesthesia under experimental conditions (Taylor, P A and Towey, R M, Brit. Med. J. 1971, 2: 688), in clinical practice aspiration is seldom a problem. In surgical procedures involving visceral pain pathways, Ketamine should be supplemented with an agent which obtunds visceral pain.
When Ketamine is used on an outpatient basis, the patient should not be released until recovery from anaesthesia is complete and then should be accompanied by a responsible adult.
Ketamine should be used with caution in patients with the following conditions:
Use with caution in the chronic alcoholic and the acutely alcohol-intoxicated patient. Ketamine is metabolised in the liver and hepatic clearance is required for termination of clinical effects. A prolonged duration of action may occur in patients with cirrhosis or other types of liver impairment.
4 Special Warnings and Special Precautions for Use) Dosage in Obstetrics Data are lacking for intramuscular injection and maintenance infusion of ketamine in the parturient population, and recommendations cannot be made. 2. Maintenance of general anaesthesia Lightening of anaesthesia may be indicated by nystagmus, movements in response to stimulation, and vocalization.
Anaesthesia is maintained by the administration of additional doses of Ketamine by either the intravenous or intramuscular route. Each additional dose is from ½ to the full induction dose recommended above for the route selected for maintenance, regardless of the route used for induction.
The larger the total amount of Ketamine administered, the longer will be the time to complete recovery. Purposeless and tonic-clonic movements of extremities may occur during the course of anaesthesia. These movements do not imply a light plane and are not indicative of the need for additional doses of the anaesthetic.
B. Ketamine as induction agent prior to the use of other general anaesthetics Induction is accomplished by a full intravenous or intramuscular dose of Ketamine as defined above. If Ketamine has been administered intravenously and the principal anaesthetic is slow-acting, a second dose of Ketamine may be required 5 to 8 minutes following the initial dose.
If Ketamine has been administered intramuscularly and the principal anaesthetic is rapid-acting, administration of the principal anaesthetic may be delayed up to 15 minutes following the injection of Ketamine. C. Ketamine as supplement to anaesthetic agents Ketamine is clinically compatible with the commonly used general and local anaesthetic agents when an adequate respiratory exchange is maintained.
The dose of Ketamine for use in conjunction with other anaesthetic agents is usually in the same range as the dosage stated above; however, the use of another anaesthetic agent may allow a reduction in the dose of Ketamine. D. Management of patients in recovery Following the procedure the patient should be observed but left undisturbed.
8 Undesirable effects). 1. - In patients with eclampsia or pre-eclampsia.
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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The rate of infusion will depend on the patient’s reaction and response to anaesthesia. The dosage required may be reduced when a long acting neuromuscular blocking agent is used. 0 mg/kg. It is recommended that intravenous administration be accomplished slowly (over a period of 60 seconds).
More rapid administration may result in respiratory depression and enhanced pressor response. 6 Fertility, pregnancy and lactation). 5 mg/kg to 13 mg/kg (in terms of ketamine base). A low initial intramuscular dose of 4 mg/kg has been used in diagnostic manoeuvres and procedures not involving intensely painful stimuli.
A dose of 10 mg/kg will usually produce 12 to 25 minutes of surgical anaesthesia.
Dosage in Hepatic Insufficiency:
Dose reductions should be considered in patients with cirrhosis or other types of liver impairment. (see section
Dose reductions should be considered in these patients. Abnormal liver function tests associated with ketamine use have been reported, particularly with extended use (>3 days) or drug abuse. Since an increase in cerebrospinal fluid (CSF) pressure has been reported during Ketamine anaesthesia, Ketamine should be used with special caution in patients with preanaesthetic elevated cerebrospinal fluid pressure.
g. schizophrenia, acute psychosis). g. glaucoma) because the pressure may increase significantly after a single dose of ketamine. Use in caution in patients with acute intermittent porphyria. Use in caution in patients with hyperthyroidism or patients receiving thyroid replacement (increased risk of hypertension and tachycardia).
Use in caution in patients with pulmonary or upper respiratory infection (ketamine sensitises the gag reflex, potentially causing laryngospasm) Use in caution in patients with intracranial mass lesions, a presence of head injury, or Hydrocephalus.
Emergence Reaction The psychological manifestations vary in severity between pleasant dream-like states, vivid imagery, hallucinations, nightmares and emergence delirium (often consisting of dissociative or floating sensations), In some cases these states have been accompanied by confusion, excitement, and irrational behaviour which a few patients recall as an unpleasant experience.
8 Undesirable Effects). Emergence delirium phenomena may occur during the recovery period. The incidence of these reactions may be reduced if verbal and tactile stimulation of the patient is minimised during the recovery period. This does not preclude the monitoring of vital signs.
g. congestive heart failure, myocardial ischemia and myocardial infarction). In addition ketamine should be used with caution in patients with mild-to-moderate hypertension and tachyarrhythmias. Cardiac function should be continually monitored during the procedure in patients found to have hypertension or cardiac decompensation.
Elevation of blood pressure begins shortly after the injection of Ketamine, reaches a maximum within a few minutes and usually returns to preanaesthetic values within 15 minutes after injection. The median peak rise of blood pressure in clinical studies has ranged from 20 to 25 percent of preanaesthetic values.
Depending on the condition of the patient, this elevation of blood pressure may be considered a beneficial effect, or in others, an adverse reaction.
Long-Term use:
Cases of cystitis including haemorrhagic cystitis, acute kidney injury, hydronephrosis and ureteral disorders have been reported in patients being given ketamine on a long term basis, especially in the setting of ketamine abuse. This adverse reaction develops in patients receiving long term ketamine treatment after a time ranging from 1 month to several years.
Ketamine is not indicated nor recommended for long term use.
Drug Abuse and Dependence:
Ketamine has been reported as being a drug of abuse. Reports suggest that ketamine produces a variety of symptoms including, but not limited to, flashbacks, hallucinations, dysphoria, anxiety, insomnia, or disorientation. Adverse effects have also been reported: see “Long-Term Use”.
If used on a daily basis for a few weeks, dependence and tolerance may develop, particularly in individuals with a history of drug abuse and dependence. Therefore, the use of Ketamine should be closely supervised and it should be prescribed and administered with caution.
Cases of hepatic disorders, in particular cholestatic of cholangitis type, that may be severe, have been reported in case of prolonged (> 3 days) and/or repeated use or in […]
This does not preclude the monitoring of vital signs. V. in an adult). ) may be used to terminate severe emergence reactions. If any one of these agents is employed, the patient may experience a longer recovery period. 6. 8 Undesirable effects).
1. - In patients with eclampsia or pre-eclampsia. 4 Special warnings and precautions for use To be used only in hospitals by or under the supervision of experienced medically qualified anaesthetists except under emergency conditions.
As with any general anaesthetic agent, resuscitative equipment should be available and ready for use. Respiratory depression may occur with overdosage of Ketamine, in which case supportive ventilation should be employed. Mechanical support of respiration is preferred to the administration of analeptics.
The intravenous dose should be administered over a period of 60 seconds. More rapid administration may result in transient respiratory depression or apnoea and enhanced pressor response. Because pharyngeal and laryngeal reflexes usually remain active, mechanical stimulation of the pharynx should be avoided unless muscle relaxants, with proper attention to respiration, are used.
Although aspiration of contrast medium has been reported during Ketamine anaesthesia under experimental conditions (Taylor, P A and Towey, R M, Brit. Med. J. 1971, 2: 688), in clinical practice aspiration is seldom a problem. In surgical procedures involving visceral pain pathways, Ketamine should be supplemented with an agent which obtunds visceral pain.
When Ketamine is used on an outpatient basis, the patient should not be released until recovery from anaesthesia is complete and then should be accompanied by a responsible adult.
Ketamine should be used with caution in patients with the following conditions:
Use with caution in the chronic alcoholic and the acutely alcohol-intoxicated patient. Ketamine is metabolised in the liver and hepatic clearance is required for termination of clinical effects. A prolonged duration of action may occur in patients with cirrhosis or other types of liver impairment.
Dose reductions should be considered in these patients. Abnormal liver function tests associated with ketamine use have been reported, particularly with extended use (>3 days) or drug abuse. Since an increase in cerebrospinal fluid (CSF) pressure has been reported during Ketamine anaesthesia, Ketamine should be used with special caution in patients with preanaesthetic elevated cerebrospinal fluid pressure.
g. schizophrenia, acute psychosis). g. glaucoma) because the pressure may increase significantly after a single dose of ketamine. Use in caution in patients with acute intermittent porphyria. Use in caution in patients with hyperthyroidism or patients receiving thyroid replacement (increased risk of hypertension and tachycardia).
Use in caution in patients with pulmonary or upper respiratory infection (ketamine sensitises the gag reflex, potentially causing […]