Cetamine Uses

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Cetamine Uses

Ketamine Guide: Effects, Common Uses, Safety

Cetamine Uses

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Cetamine Uses

Last updated on 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 procedures. If skeletal muscle relaxation is desired, a muscle relaxant should be used and respiration should be supported. For the induction of anaesthesia prior to the administration of other general anaesthetic agents. To supplement other anaesthetic agents. Debridement, painful dressings, and skin grafting in burned patients, as well as other superficial surgical procedures. Neurodiagnostic procedures such as pneumoencephalograms, ventriculograms, myelograms, and lumbar punctures. Diagnostic and operative procedures of the eye, ear, nose, and mouth, including dental extractions. Anaesthesia in poor-risk patients with depression of vital functions or where depression of vital functions must be avoided, if at all possible. Orthopaedic procedures such as closed reductions, manipulations, femoral pinning, amputations, and biopsies. Anaesthesia in the asthmatic patient, either to minimise the risks of an attack of bronchospasm developing, or in the presence of bronchospasm where anaesthesia cannot be delayed. For surgery in elderly patients ketamine has been shown to be suitable either alone or supplemented with other anaesthetic agents. 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. Premedication with an anticholinergic agent e. 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. 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. Because of rapid induction following intravenous injection, the patient should be in a supported position during administration. Return to consciousness is gradual. 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. The dosage required may be reduced when a long acting neuromuscular blocking agent is used. The average amount required to produce 5 to 10 minutes of surgical anaesthesia has been 2. 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. The initial dose of Ketamine administered intramuscularly may range from 6. Data are lacking for intramuscular injection and maintenance infusion of ketamine in the parturient population, and recommendations cannot be made. 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. 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. 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. 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. Following the procedure the patient should be observed but left undisturbed. This does not preclude the monitoring of vital signs. If, during the recovery, the patient shows any indication of emergence delirium, consideration may be given to the use of diazepam 5 to 10 mg I. A hypnotic dose of a thiobarbiturate 50 to mg I. If any one of these agents is employed, the patient may experience a longer recovery period. Ketamine is contra-indicated in persons in whom an elevation of blood pressure would constitute a serious hazard. Ketamine should not be used in patients with eclampsia or pre-eclampsia, severe coronary or myocardial disease, cerebrovascular accident or cerebral trauma. 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. 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. 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. 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.. 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. Because of the substantial increase in myocardial oxygen consumption, ketamine should be used in caution in patients with hypovolemia, dehydration or cardiac disease, especially coronary artery disease e. 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. Cases of cystitis including haemorrhagic cystitis have been reported in patients being given ketamine on a long term basis. 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. 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. Cases of cystitis including haemorrhagic cystitis and cases of hepatotoxicity have also been reported. 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. Ketamine is chemically incompatible with barbiturates and diazepam because of precipitate formation. Therefore, these should not be mixed in the same syringe or infusion fluid. Ketamine may potentiate the neuromuscular blocking effects of atracurium and tubocurarine including respiratory depression with apnoea. The use of halogenated anaesthetics concomitantly with ketamine can lengthen the elimination half-life of ketamine and delay recovery from anaesthesia. Concurrent use of ketamine especially in high doses or when rapidly administered with halogenated anaesthetics can increase the risk of developing bradycardia, hypotension or decreased cardiac output. The use of ketamine with other central nervous system CNS depressants e. Reduced doses of ketamine may be required with concurrent administration of other anxiolytics, sedatives and hypnotics. Patients taking thyroid hormones have an increased risk of developing hypertension and tachycardia when given ketamine. Concomitant use of antihypertensive agents and ketamine increases the risk of developing hypotension. When ketamine and theophylline are given concurrently, a clinically significant reduction in the seizure threshold is observed. Unpredictable extensor-type seizures have been reported with concurrent administration of these agents. Drugs that inhibit CYP3A4 enzyme activity generally decrease hepatic clearance, resulting in increased plasma concentration of CYP3A4 substrate medications, such as ketamine. Coadministration of ketamine with drugs that inhibit CYP3A4 enzyme may require a decrease in ketamine dosage to achieve the desired clinical outcome. Drugs that induce CYP3A4 enzyme activity generally increase hepatic clearance, resulting in decreased plasma concentration of CYP3A4 substrate medications, such as ketamine. Coadministration of ketamine with drugs that induce CYP3A4 enzyme may require an increase in ketamine dosage to achieve the desired clinical outcome. Ketamine crosses the placenta. This should be borne in mind during operative obstetric procedures in pregnancy. No controlled clinical studies in pregnancy have been conducted. The use in pregnancy has not been established and such use is not recommended, with the exception of administration during surgery for abdominal delivery or vaginal delivery. The safe use of ketamine during lactation has not been established, and such use is not recommended. Patients should be cautioned that driving a car, operating hazardous machinery or engaging in hazardous activities should not be undertaken for 24 hours or more after anaesthesia. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act When prescribing this medicine, patients should be told:. Reporting suspected adverse reactions after authorisation of the medicinal product is important. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www. Respiratory depression can result from an overdosage of ketamine hydrochloride. Supportive ventilation should be employed. Mechanical support of respiration that will maintain adequate blood oxygen saturation and carbon dioxide elimination is preferred to administration of analeptics. Ketamine has a wide margin of safety; several instances of unintentional administration of overdoses of Ketamine up to 10 times that usually required have been followed by prolonged but complete recovery. Ketamine is a rapidly acting general anaesthetic for intravenous or intramuscular use with a distinct pharmacological action. Ketamine hydrochloride produces dissociative anaesthesia characterised by catalepsy, amnesia, and marked analgesia which may persist into the recovery period. Pharyngeal-laryngeal reflexes remain normal and skeletal muscle tone may be normal or can be enhanced to varying degrees. Mild cardiac and respiratory stimulation and occasionally respiratory depression occur. Ketamine induces sedation, immobility, amnesia and marked analgesia. It may selectively depress the thalamoneocortical system before significantly obtunding the more ancient cerebral centres and pathways reticular-activating and limbic systems. Numerous theories have been proposed to explain the effects of ketamine, including binding to N-methyl-D-aspartate NMDA receptors in the CNS, interactions with opiate receptors at central and spinal sites and interaction with norepinephrine, serotonin and muscarinic cholinergic receptors. The activity on NMDA receptors may be responsible for the analgesic as well as psychiatric psychosis effects of ketamine. Ketamine has sympathomimetic activity resulting in tachycardia, hypertension, increased myocardial and cerebral oxygen consumption, increased cerebral blood flow and increased intracranial and intraocular pressure. Ketamine is also a potent bronchodilator. Clinical effects observed following ketamine administration include increased blood pressure, increased muscle tone may resemble catatonia , opening of eyes usually accompanied by nystagmus and increased myocardial oxygen consumption. Ketamine is rapidly distributed into perfused tissues including brain and placenta. Animal studies have shown ketamine to be highly concentrated in body fat, liver and lung. In humans at an intravenous bolus dose of 2. Plasma ketamine concentrations are about 1. In parturients receiving an intramuscular dose of mg approximately 4. Average delivery time for these parturients was 12 minutes from the time of ketamine injection to vaginal delivery of a newborn. Biotransformation takes place in liver. Termination of anaesthetic is partly by redistribution from brain to other tissues and partly by metabolism. Elimination half-life is approximately hours, and excretion renal, mostly as conjugated metabolites. Animal research has shown that ketamine can induce NMDA antagonist-induced neuronal cell death in juvenile animals apoptosis when administered in high doses, for prolonged periods, or both. In some cases this led to abnormalities in behaviour, learning and memory. The relevance of this finding to human use is unknown. This medicinal product does not require any special temperature storage conditions. Do not freeze. Store in the original container. Email Successfully Sent. Ketamine Print. Name of the medicinal product. Interaction with other medicinal products and other forms of interaction. Special precautions for disposal and other handling. Components: Ketamine. Method of action: Analgesic, Anesthesia, Anesthetic, Hypnotic. Available in countries. Qualitative and quantitative composition. Each 1 ml of solution contains: Ketamine hydrochloride equivalent to 50 mg ketamine base per ml. Pharmaceutical form. Solution for injection or infusion. A clear solution for injection or infusion. Therapeutic indications. Ketamine is indicated in children and in adults. Ketamine is recommended: As an anaesthetic agent for diagnostic and surgical procedures. Specific areas of application or types of procedures: When the intramuscular route of administration is preferred. Note: Eye movements may persist during ophthalmological procedures. Sigmoidoscopy and minor surgery of the anus and rectum, circumcision and pilonidal sinus. Cardiac catheterization procedures. Caesarean section; as an induction agent in the absence of elevated blood pressure. Dosage Posology and method of administration. 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. 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. 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. General Anaesthesia Induction An infusion corresponding to 0. Dosage in Obstetrics Intramuscular Route The initial dose of Ketamine administered intramuscularly may range from 6. Maintenance of general anaesthesia Lightening of anaesthesia may be indicated by nystagmus, movements in response to stimulation, and vocalization. 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. 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. Management of patients in recovery Following the procedure the patient should be observed but left undisturbed. Special warnings and precautions for use. 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. 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. Cardiovascular Because of the substantial increase in myocardial oxygen consumption, ketamine should be used in caution in patients with hypovolemia, dehydration or cardiac disease, especially coronary artery disease e. Long-Term Use Cases of cystitis including haemorrhagic cystitis have been reported in patients being given ketamine on a long term basis. Drug Abuse and Dependence Ketamine has been reported as being a drug of abuse. Ketamine has been reported to antagonise the hypnotic effect of thiopental. Fertility, pregnancy and lactation. Pregnancy Ketamine crosses the placenta. Lactation The safe use of ketamine during lactation has not been established, and such use is not recommended. Effects on ability to drive and use machines. Undesirable effects. Pharmacodynamic properties. Pharmacotherapeutic group: Other general anesthetics. ATC Code: N01A X03 Ketamine is a rapidly acting general anaesthetic for intravenous or intramuscular use with a distinct pharmacological action. Mechanism of Action: Ketamine induces sedation, immobility, amnesia and marked analgesia. Pharmacokinetic properties. Absorption Ketamine is rapidly absorbed following intra-muscular administration. Distribution Ketamine is rapidly distributed into perfused tissues including brain and placenta. Biotransformation Biotransformation takes place in liver. Elimination Elimination half-life is approximately hours, and excretion renal, mostly as conjugated metabolites. Pharmacotherapeutic group. Preclinical safety data. List of excipients. Shelf life. For single use only. Discard any unused product. After dilution the solutions should be used immediately. Special precautions for storage. Nature and contents of container. Carton pack containing 1 or 10 Type I clear glass vials of 10ml of solution. Not all pack sizes may be marketed. Marketing authorisation holder. Marketing authorisation number s. Date of revision of the text. Find in a country: A.

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Medically reviewed by Drugs. Ketamine is used to put you to sleep for surgery and to prevent pain and discomfort during certain medical tests or procedures. You should not be treated with ketamine if you have untreated or uncontrolled hypertension high blood pressure. Tell your caregivers at once if you have serious side effects within 24 hours after you receive ketamine, including severe confusion, hallucinations, unusual thoughts, or extreme fear. You should not receive ketamine if you are allergic to it, or if you have untreated or uncontrolled hypertension high blood pressure. Anesthesia medicine may affect brain development in a child under 3, or an unborn baby whose mother receives ketamine during late pregnancy. These effects may be more likely when the anesthesia is used for 3 hours or longer, or used for repeated procedures. Effects on brain development could cause learning or behavior problems later in life. Negative brain effects from anesthesia have been seen in animal studies. However, studies in human children receiving single short uses of anesthesia have not shown a likely effect on behavior or learning. More research is needed. In some cases, your doctor may decide to postpone a surgery or procedure based on these risks. Treatment may not be delayed in the case of life-threatening conditions, medical emergencies, or surgery needed to correct certain birth defects. Ask your doctor for information about all medicines that will be used during your surgery or procedure. Also ask how long the procedure will last. It may not be safe to breast-feed shortly after receiving this medicine. Ask your doctor about any risk. Ketamine is injected into a muscle, or as an infusion into a vein. You will receive this injection in a clinic or hospital setting. Your breathing, blood pressure, heart function, and other vital signs will be watched closely while you are receiving ketamine. You may feel strange or slightly confused when you first come out of anesthesia. Tell your caregivers if these feelings are severe or unpleasant. Since ketamine is given by a healthcare professional in a medical setting, an overdose is unlikely to occur. Your vital signs will be closely watched while you are under anesthesia to make sure the medication is not causing any harmful effects. You will probably not be allowed to drive yourself home after your surgery or medical procedure. Avoid driving or operating machinery for at least 24 hours after you have received ketamine. Get emergency medical help if you have signs of an allergic reaction : hives ; difficult breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have any of these serious side effects within 24 hours after you receive ketamine : severe confusion, hallucinations, unusual thoughts, or extreme fear. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. Ketamine side effects in more detail. IV: -Induction: 1 to 4. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia. IM: -Induction: 6. Comments: -This drug should be administered slowly over a period of 60 seconds more rapid administration may result in respiratory depression and enhanced pressor response. If you are using any drugs that make you sleepy or slow your breathing, it may take you longer to recover from anesthesia with ketamine. This includes opioid medication, a sleeping pill, a muscle relaxer, or medicine for anxiety or seizures. Other drugs may affect ketamine, including prescription and over-the-counter medicines, vitamins , and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using. Ketamine drug interactions in more detail. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Other brands: Ketalar. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Available for Android and iOS devices. Subscribe to Drugs. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. We comply with the HONcode standard for trustworthy health information - verify here. Skip to Content. See also: Ketamine side effects in more detail. See also: Ketamine drug interactions in more detail. Drug Status Rx. Availability Prescription only. Mylan Pharmaceuticals Inc. Pfizer Inc. Drug Class. General anesthetics. Related Drugs. 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Cetamine Uses

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