KETAMINE

Class

A rapid-acting general anesthetic, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression.

Pharmacology and Actions

1. Produces an anesthetic state characterized by profound analgesia
2. Normal or  slightly enhanced skeletal muscle tone
3. Cardiovascular and respiratory stimulation
4. Occasionally a transient and minimal respiratory depression.

Indications

1. Adult patient with signs of excited delirium where the safety of patient and/or providers is of substantial concern.

Contraindications

1. Relatively contraindicated in penetrating eye trauma
2. Relative contraindication in patients with known cardiovascular disease. (ketamine causes tachycardia

Administration

1. Administer 1mg/kg IV/IO or 4mg/kg IM.
2. May administer a second dose after 5 minutes if the patient is not adequately sedated, only after consult with MEDICAL CONTROL
   1. For any signs of emergence phenomena, such as hallucinations, delirium, or increasing agitation, contact MEDICAL CONTROL for discussion of supplemental Versed.
3. If post-Ketamine sedation is necessary, contact MEDICAL CONTROL for discussion of supplemental Versed.

Side Effects and Special Notes

1. Laryngospasm:  this very rare adverse reaction presents with stridor and respiratory distress.  After every administration of ketamine:
   1. Prepare to provide respiratory support including bag-valve-mask ventilation and suction, which are generally sufficient in rare cases of laryngospasm.
   2. Institute cardiac monitoring, pulse oximetry and continuous waveform capnography
   3. Establish IV or IO access, check blood glucose
   4. Establish and maintain physical restraint.
2. Emergence Reaction:  presents as anxiety, agitation, apparent hallucinations or nightmares as ketamine is wearing off. For severe reactions, consider benzodiazepine.
3. Nausea and Vomiting: always have suction available after ketamine administration. Give antiemetic as needed.
4. Hypersalivation: Suction usually sufficient.