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

NPO (>3hrs = rec; no evidence of need)

Consent

Monitor

BVM/O2 mask

Suction

Ketamine (drawn up)

Atropine (ready) [0.01 mg/kg IVP; min 0.1mg, max 0.5mg]

Versed (ready) [0.05mg/kg IVP]

"Happy Place"

Give initial bolus 2 mg/kg SLOW IV* (over 1 min)

Nystagmus = effect

?maximal dose = 6mg/kg at one time

May repeat boluses at 1 mg/kg increments

-O2 ready vs on (no data)

-Most don't give atropine prophy (some <5yrs; no evidence)

-Most don't give versed prophy (evidence against)

1) Transient rash (common)

   -not harmful

2) Hypersalvation (1.7%)

   -may give atropine

   -suction sides only

3) Laryngospasm (<0.4%)

   -not dose-dependent

   -assoc with fast IVP

   -assoc with procedures stimulating gag

4) Transient apnea (<0.3%)

   -around 2min after IVP

   -normally BVM needed only

5) Emergence Rx (~2% mod-severe)

   -give benzo

6) Emesis/persistent ataxia

   -typically during recovery

   -no cases of aspiration (airway reflex maintained)

   -no driving!

Prolonged sedation --> full recovery

3/06 DONALDSON (Adapted from Young)

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