Ketamine

Contraindications

1. <3-6 mo old
2. Increased ICP
3. Glaucoma/acute globe (increased IOP)
4. CAD, HTN, CHF (? >40 yr old )
5. URI or active asthma (unless for induction)
6. Procedures stimulating gag
7. Porphyria/thyroid (theoretical)
8. ?Increased intra-abd pressure

Preparation

1. NPO (>3hrs = rec; no evidence of need)
2. Consent
3. Monitor
4. BVM/O2 mask
5. Suction
6. Ketamine (drawn up)
7. Atropine (ready) [0.01 mg/kg IVP; min 0.1mg, max 0.5mg]
8. Versed (ready) [0.05mg/kg IVP]
9. "Happy Place"

Conscious Sedation

1. Give initial bolus 2 mg/kg SLOW IV* (over 1 min)
   1. Nystagmus = effect
   2. ?maximal dose = 6mg/kg at one time
2. May repeat boluses at 1 mg/kg increments
3. prefered by most over IM 4 mg/kg

O2 ready vs on

1. No data
2. Most don't give atropine prophy (some <5yrs; no evidence)
3. Most don't give versed prophy (evidence against)

Side Effects

1. Transient rash (common)
   1. not harmful
2. Hypersalvation (1.7%)
   1. may give atropine
   2. suction sides only
3. Laryngospasm (<0.4%)
   1. not dose-dependent
   2. assoc with fast IVP
   3. assoc with procedures stimulating gag
4. Transient apnea (<0.3%)
   1. around 2min after IVP
   2. normally BVM needed only
5. Emergence Rx (~2% mod-severe)
   1. give benzo
6. Emesis/persistent ataxia
   1. typically during recovery
   2. no cases of aspiration (airway reflex maintained)
   3. no driving!

Overdose

Prolonged sedation --> full recovery

Source

3/06 DONALDSON (Adapted from Young)