see: [[Laryngospasm]] [RCH - Ketamine](https://www.rch.org.au/clinicalguide/guideline_index/Ketamine_use_for_procedural_sedation/), [Hayes’ - Ketamine](x-devonthink-item://B3391057-7B46-4628-AB04-419D5F9DAC2A) # Doses | Route | dose | | --------------------------- | -------------------------------------------------------------------------------- | | induction | 1-2mg/kg IV | | infusion (rare)<br>sedation | 10-40 mcg/kg/min <br>0.6-2.4mg/kg/hour (paeds)<br>0.2-1mg/kg/h (adult eg asthma) | | infusion (analgesia) | 0.1-0.3 mg/kg/hour | | Intranasal | 1mg/kg | | IM | 4mg/kg | | Procedural sedation | 1mg/kg IV . ↑ in 0.25- 0.5mg/kg increments | | Analgesia | 0.15 - 0.3 mg/kg IV | # procedural sedation routes | | IM | IV | | ----------------- | --------------------------------------------------------------------------- | ----------------------------------------------------------------------- | | advantages | - no IV necessary<br>- less aponea | - easy to repeat dose<br>- slightly faster recovery | | disadvantage | - pain on injection<br>- longer onset/offset<br>- more difficult to titrate | - requires cannula<br>- ↓ duration of sedation<br>- aponea if push dose | | clinical onset | 5 min | 30-60 seconds | | duration | 15-30 min | 10 - 20 min | | dose | 4 mg/kg | 0.5 - 1.5 mg/kg | | repeat dosing | 1-2 mg/kg IM after 10 min | 0.25 - 0.5 mg/kg slowly or less | | time to discharge | 100-140 min | 90-120 min | # Adverse Effects of ketamine - mild hypertension and tachycardia - hypotension if catecholamines depleted (eg compensated shock - salivation, bronchorrhoea - [[Laryngospasm]] - vomiting - transient respiratory depression / aponea with rapid IV injection - dysphoria and emergence phenomenon - prolonged ED length of stay after procedural sedation compared with other agents - raised IOP of ~3mmHg; likely minimal significance # Contraindications to ketamine - lack of consent - no available monitored bed - history of airway surgery or congeintal abnormality - severe HTN - poorly controlled seizure disorder - glaucoma or acute globe injury - psychosis - porphyria - < 3 months of age ( relative if < 12 months) due to ↑ resp complications