Cetamine Uses

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Cetamine Uses

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Last updated on As an anaesthetic agent for diagnostic and surgical procedures. When used by intravenous or intramuscular injection, Кетамин is best suited for short procedures. With additional doses, or by intravenous infusion, Кетамин 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. Кетамин injection is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Кетамин is best suited for short procedures but it can be used, with additional doses, for longer procedures. Кетамин injection is indicated for the induction of anesthesia prior to the administration of other general anesthetic agents. For surgery in elderly patients Кетамин has been shown to be suitable either alone or supplemented with other anaesthetic agents. Кетамин 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 Кетамин, have been effective in reducing the incidence of emergence reactions. As with other general anaesthetic agents, the individual response to Кетамин 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 Кетамин 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 Кетамин administered intramuscularly may range from 6. Data are lacking for intramuscular injection and maintenance infusion of Кетамин 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 Кетамин by either the intravenous or intramuscular route. The larger the total amount of Кетамин 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 Кетамин as defined above. If Кетамин has been administered intravenously and the principal anaesthetic is slow- acting, a second dose of Кетамин may be required 5 to 8 minutes following the initial dose. If Кетамин 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 Кетамин. Кетамин is clinically compatible with the commonly used general and local anaesthetic agents when an adequate respiratory exchange is maintained. The dose of Кетамин 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 Кетамин. 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. Note: Barbiturates and Кетамин, being chemically incompatible because of precipitate formation, should not be injected from the same syringe. If the Кетамин dose is augmented with diazepam, the two drugs must be given separately. Do not mix ketamine hydrochloride and diazepam in syringe or infusion flask. Because of rapid induction following the initial intravenous injection, the patient should be in a supported position during administration. If a longer effect is desired, additional increments can be administered intravenously or intramuscularly to maintain anesthesia without producing significant cumulative effects. As with other general anesthetic agents, the individual response to Кетамин is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. In addition, diazepam in 2 mg to 5 mg doses, administered in a separate syringe over 60 seconds, may be used. In most cases, 15 mg of intravenous diazepam or less will suffice. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this induction dosage program. It is recommended that Кетамин be administered slowly over a period of 60 seconds. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia. However, it should be noted that purposeless and tonic-clonic movements of extremities may occur during the course of anesthesia. These movements do not imply a light plane and are not indicative of the need for additional doses of the anesthetic. It should be recognized that the larger the total dose of Кетамин administered, the longer will be the time to complete recovery. Adult patients induced with Кетамин augmented with intravenous diazepam may be maintained on Кетамин given by slow microdrip infusion technique at a dose of 0. In many cases 20 mg or less of intravenous diazepam total for combined induction and maintenance will suffice. However, slightly more diazepam may be required depending on the nature and duration of the operation, physical status of the patient, and other factors. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this maintenance dosage program. The resultant solution will contain 1 mg of ketamine per mL. The fluid requirements of the patient and duration of anesthesia must be considered when selecting the appropriate dilution of Кетамин injection. Кетамин is clinically compatible with the commonly used general and local anesthetic agents when an adequate respiratory exchange is maintained. The regimen of a reduced dose of Кетамин supplemented with diazepam can be used to produce balanced anesthesia by combination with other agents such as nitrous oxide and oxygen. Кетамин is contra-indicated in persons in whom an elevation of blood pressure would constitute a serious hazard. Кетамин should not be used in patients with eclampsia or pre-eclampsia, severe coronary or myocardial disease, cerebrovascular accident or cerebral trauma. Кетамин is contraindicated in those in whom a significant elevation of blood pressure would constitute a serious hazard and in those who have shown hypersensitivity to the drug. 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 Кетамин, 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, Кетамин should be supplemented with an agent which obtunds visceral pain. When Кетамин 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, Кетамин should be used in caution in patients with hypovolemia, dehydration or cardiac disease, especially coronary artery disease e. In addition Кетамин 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 Кетамин, 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 Кетамин on a long term basis. This adverse reaction develops in patients receiving long term Кетамин treatment after a time ranging from 1 month to several years. Кетамин is not indicated nor recommended for long term use. Кетамин has been reported as being a drug of abuse. Reports suggest that Кетамин 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 Кетамин should be closely supervised and it should be prescribed and administered with caution. Postoperative confusional states may occur during the recovery period. See Special Note. Respiratory depression may occur with overdosage or too rapid a rate of administration of Кетамин, in which case supportive ventilation should be employed. Mechanical support of respiration is preferred to administration of analeptics. Кетамин injection should be used by or under the direction of physicians experienced in administering general anesthetics and in maintenance of an airway and in the control of respiration. Because pharyngeal and laryngeal reflexes are usually active, Кетамин should not be used alone in surgery or diagnostic procedures of the pharynx, larynx, or bronchial tree. Mechanical stimulation of the pharynx should be avoided, whenever possible, if Кетамин is used alone. Muscle relaxants, with proper attention to respiration, may be required in both of these instances. The incidence of emergence reactions may be reduced if verbal and tactile stimulation of the patient is minimized during the recovery period. This does not preclude the monitoring of vital signs see Special Note. More rapid administration may result in respiratory depression or apnea and enhanced pressor response. An increase in cerebrospinal fluid pressure has been reported following administration of Кетамин. Use with extreme caution in patients with preanesthetic elevated cerebrospinal fluid pressure. Since the safe use in pregnancy, including obstetrics either vaginal or abdominal delivery , has not been established, such use is not recommended see Animal Pharmacology And Toxicology , Reproduction. Clinical studies of Кетамин did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. 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. Cardiovascular: Blood pressure and pulse rate are frequently elevated following administration of Кетамин alone. However, hypotension and bradycardia have been observed. Arrhythmia has also occurred. Respiration: Although respiration is frequently stimulated, severe depression of respiration or apnea may occur following rapid intravenous administration of high doses of Кетамин. Laryngospasms and other forms of airway obstruction have occurred during ketamine hydrochloride anesthesia. Eye: Diplopia and nystagmus have been noted following Кетамин administration. It also may cause a slight elevation in intraocular pressure measurement. Genitourinary: Severe irritative and inflammatory urinary tract and bladder symptoms including cystitis have been reported in individuals with history of chronic ketamine use or abuse. General: Anaphylaxis. Local pain and exanthema at the injection site have infrequently been reported. For medical advice about adverse reactions contact your medical professional. Reports suggest that ketamine produces a variety of symptoms including, but not limited to anxiety, dysphoria, disorientation, insomnia, flashbacks, hallucinations, and psychotic episodes. Ketamine dependence and tolerance are possible following prolonged administration. A withdrawal syndrome with psychotic features has been described following discontinuation of long-term ketamine use. Therefore, ketamine should be prescribed and administered with caution. Respiratory depression can result from an overdosage of Кетамин 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. Кетамин has a wide margin of safety; several instances of unintentional administration of overdoses of Кетамин up to 10 times that usually required have been followed by prolonged but complete recovery. Кетамин is a rapidly acting general anaesthetic for intravenous or intramuscular use with a distinct pharmacological action. Кетамин 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. Кетамин 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 Кетамин, 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 Кетамин. Кетамин has sympathomimetic activity resulting in tachycardia, hypertension, increased myocardial and cerebral oxygen consumption, increased cerebral blood flow and increased intracranial and intraocular pressure. Кетамин is also a potent bronchodilator. Clinical effects observed following Кетамин administration include increased blood pressure, increased muscle tone may resemble catatonia , opening of eyes usually accompanied by nystagmus and increased myocardial oxygen consumption. Кетамин is rapidly distributed into perfused tissues including brain and placenta. Animal studies have shown Кетамин to be highly concentrated in body fat, liver and lung. In humans at an intravenous bolus dose of 2. Plasma Кетамин 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 Кетамин 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 Кетамин 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. Кетамин is chemically incompatible with barbiturates and diazepam because of precipitate formation. Therefore, these should not be mixed in the same syringe or infusion fluid. Email Successfully Sent. Кетамин Print. Name of the medicinal product. Special precautions for disposal and other handling. Components: Ketamine. Method of action:. Available in countries. Qualitative and quantitative composition. Therapeutic indications. Solution for intravenous and intramuscular injection. Кетамин is indicated in children and in adults. Кетамин 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. Кетамин injection is indicated to supplement low-potency agents, such as nitrous oxide. Dosage Posology and method of administration. For intravenous infusion, intravenous injection or intramuscular injection. NOTE: All doses are given in terms of Кетамин base Adults, elderly over 65 years and children: For surgery in elderly patients Кетамин has been shown to be suitable either alone or supplemented with other anaesthetic agents. Preoperative preparations Кетамин has been safely used alone when the stomach was not empty. Onset and duration As with other general anaesthetic agents, the individual response to Кетамин 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. Кетамин as the sole anaesthetic agent Intravenous Infusion The use of Кетамин 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 Кетамин 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. Кетамин as induction agent prior to the use of other general anaesthetics Induction is accomplished by a full intravenous or intramuscular dose of Кетамин as defined above. Кетамин as supplement to anaesthetic agents Кетамин 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. Preoperative Preparations While vomiting has been reported following ketamine hydrochloride administration, some airway protection may be afforded because of active laryngeal-pharyngeal reflexes. However, since aspiration may occur with Кетамин and since protective reflexes may also be diminished by supplementary anesthetics and muscle relaxants, the possibility of aspiration must be considered. Кетамин is recommended for use in the patient whose stomach is not empty when, in the judgment of the practitioner, the benefits of the drug outweigh the possible risks. Atropine, scopolamine, or another drying agent should be given at an appropriate interval prior to induction. Onset And Duration Because of rapid induction following the initial intravenous injection, the patient should be in a supported position during administration. Dosage As with other general anesthetic agents, the individual response to Кетамин is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. Rate of Administration It is recommended that Кетамин be administered slowly over a period of 60 seconds. Intramuscular Route The initial dose of Кетамин administered intramuscularly may range from 6. Supplementary Agents Кетамин is clinically compatible with the commonly used general and local anesthetic agents when an adequate respiratory exchange is maintained. Special warnings and precautions for use. Кетамин 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, Кетамин 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 Кетамин on a long term basis. Drug Abuse and Dependence Кетамин has been reported as being a drug of abuse. Resuscitative equipment should be ready for use. Use with caution in the chronic alcoholic and the acutely alcohol-intoxicated patient. Usage In Pregnancy Since the safe use in pregnancy, including obstetrics either vaginal or abdominal delivery , has not been established, such use is not recommended see Animal Pharmacology And Toxicology , Reproduction. Geriatric Use Clinical studies of Кетамин did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Pediatric Use Safety and effectiveness in pediatric patients below the age of 16 have not been established. Effects on ability to drive and use machines. Undesirable effects. Psychological: See Special Note. Drug Abuse And Dependence Ketamine has been reported being used as a drug of abuse. Pharmacodynamic properties. Pharmacotherapeutic group: Other general anesthetics. ATC Code: N01A X03 Кетамин is a rapidly acting general anaesthetic for intravenous or intramuscular use with a distinct pharmacological action. Mechanism of Action: Кетамин induces sedation, immobility, amnesia and marked analgesia. Pharmacokinetic properties. Absorption Кетамин is rapidly absorbed following intra-muscular administration. Distribution Кетамин 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. Find in a country: A.