Ketamine education 2014

Ketamine

Adam Frisch M.D.

For the REMO Medical Advisory Committee

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

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

Pharmacology

• Mechanism of Action: DissociationSelectively 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

Indications / Contraindications

• Indications: – RSI

– Excited Delirium

– Facilitated Extrication

– Adjunctive pain management (very low dose)

• Relative contraindications:

– Marked hypertension

– Marked tachycardia

– Cardiac ischemia

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

Must dilute for slow administration

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

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

Thanks.