Ketamine

1. Ketamine
Adam Frisch M.D.
For the
REMO Medical Advisory Committee

2. Background
• Ketamine can provide patients with sedation
and analgesia
• Patients can gain relief while still maintaining
airway protection and respiratory drive
• Paramedic level medication only
• Reporting from Medical Director required
after each use

3. Ketamine Hydrochloride
• Classification: Dissociative Anesthetic
– Sedative and analgesic properties
• Onset:
– 60-90 seconds - IV/IO
– 1-2 minutes - IM
• Duration of action:
– 10-15 minutes - IV/IO
– 15-20 minutes - IM

4. Pharmacology
• Mechanism of Action: Dissociation
Selectively disrupts association pathways of the
brain between thalamus and limbic system
– Competitive NMDA antagonist
• Ketamine is an ideal alternative to other
sedation medications because of its:
– Minimal respiratory depression
– Benefit with reactive airway disease

5. Indications / Contraindications
• Indications:
– RSI
– Excited Delirium
– Facilitated Extrication
– Adjunctive pain management (very low dose)
• Relative contraindications:
– Marked hypertension
– Marked tachycardia
– Cardiac ischemia

6. Specific information
• Supplied: (be aware of concentration)
– 100mg/mL
• Dosing:
– 1-2 mg/kg IV
– 3-5 mg/kg IM, may repeat once
• Pregnancy Category B

9. Must dilute for slow administration

10. Side Effects
• Apnea
– if rapid IV push
• Emergence reaction
• Hypersalivation
• General “uncomfortable feeling”
– In low, sub-dissociative doses
• Increased intraocular pressure
– Discuss risk/benefit with physician

11. Other
• Paramedic level administration only (no CCT)
• Physician order ONLY
• Consider benzodiazepine use with findings of
emergence phenomenon
– No need to pre-treat, however
• Consider atropine for management of
hypersalivation/secretions

12. Thanks.