Difference between revisions of "Ketamine"

Ketamine
Trade names	Ketalar
	Clinical data
Drug class	Sedative hypnotic
Uses	Induction and maintenance of anesthesia, sedation, analgesia
Contraindications	<3 months old; Situations where elevated blood pressure or myocardial oxygen demand would be dangerous; Schizophrenia; Use controversial with elevated ICP or IOP;
Routes of administration	IV, IM, IN, PO, PR
Dosage	Induction of general anesthesia: 0.5-2 mg/kg IV
	Dosage
	Pharmacodynamics
Mechanism of action	NMDA-receptor antagonism
Adverse effects	Laryngospasm Hypersalivation Emesis Emergence reaction
	Pharmacokinetics
Onset of action	IV: 15-30 seconds; IM: 3-5 minutes;
Duration of action	IV: 5-10 minutes; IM: 12-30 minutes (residual 0.5-2 hours); PO: 1-6+ hours; Context-sensitive half-time: 40-55 minutes after 8 hours of continuous infusion;
Metabolism	Liver (CYP3A4, CYP2B6)
Elimination half-life	2.5-3 hours
Protein binding	23-47%
	Physical and chemical data
Formula	C13H16ClNO
Molar mass	237.73 g/mol
	Article quality
Editor rating	In development
User likes	0

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Latest revision as of 16:50, 14 July 2022

Ketamine is a dissociative anesthetic used for the induction of anesthesia, procedural sedation, and as an analgesic adjunct.

Uses

Contraindications

Absolute contraindications

Precautions

Pharmacology

Pharmacodynamics

Mechanism of action

Adverse effects

Pharmacokinetics

Metabolized by hepatic microsomal enzymes to norketamine via N-demethylation. Norketamine is then metabolized to hydroxynorketamine. Ultimately, hydroxynorketamine undergoes glucuronide conjugation and is excreted in the urine.

Norketamine has 33% of the potency of ketamine

The plasma disappearance of ketamine is traditionally described by a two-compartment model.

Elimination half-life: 2.5-2.8 hr

Clearance: 12-17 mL/kg/min

Vd at steady state: 3.1 L/kg

Chemistry and formulation

History

References

Kamp J, Olofsen E, Henthorn TK, van Velzen M, Niesters M, Dahan A; Ketamine Pharmacokinetic Study Group. Ketamine Pharmacokinetics. Anesthesiology. 2020 Dec 1;133(6):1192-1213. doi: 10.1097/ALN.0000000000003577. PMID: 32997732.

Miller, Ronald D. Miller's Anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone/Elsevier, 2010.

Top contributors: Stuart van der Greeff, Chris Rishel and Darreon Schwartz

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-Ketamine is a dissociative anesthetic agent used for induction and maintenance of general anesthesia, sedation, and analgesia.
+{{Infobox drug reference
+| trade_names = Ketalar
+| image_file = Ketamine.svg
+| image_caption =
+| drug_class = Sedative hypnotic
+| drug_class_color = sedative_hypnotic
+| uses = Induction and maintenance of anesthesia, sedation, analgesia
+| contraindications = * <3 months old
+* Situations where elevated blood pressure or myocardial oxygen demand would be dangerous
+* Schizophrenia
+* Use controversial with elevated ICP or IOP
+| routes = IV, IM, IN, PO, PR
+| dosage = Induction of general anesthesia: 0.5-2 mg/kg IV
+| dosage_calculation = ketamine
+| mechanism = NMDA-receptor antagonism
+| adverse_effects = Laryngospasm
+Hypersalivation
+Emesis
+Emergence reaction
+| time_onset = * IV: 15-30 seconds
+* IM: 3-5 minutes
+| duration = * IV: 5-10 minutes
+* IM: 12-30 minutes (residual 0.5-2 hours)
+* PO: 1-6+ hours
+*Context-sensitive half-time: 40-55 minutes after 8 hours of continuous infusion
+| metabolism = Liver (CYP3A4, CYP2B6)
+| halflife_elimination = 2.5-3 hours
+| protein_binding = 23-47%
+| formula = C<sub>13</sub>H<sub>16</sub>ClNO
+| molar_mass = 237.73 g/mol
+}}
-Ketamine stimulates sympathetic tone and typically increases heart rate, blood pressure, and cardiac output.
+'''Ketamine''' is a dissociative anesthetic used for the induction of anesthesia, procedural sedation, and as an analgesic adjunct.
-==Uses, Dosing, & Administration<!-- Describe uses of the drug. If appropriate, add subsections for each indication. -->==
+== Uses<!-- Describe uses of the drug. If appropriate, add subsections for each indication. --> ==
- Give the drug's indications and the doses for each indication. When the drug can be given my mutltiple routes be sure to specify the route of administration. When dosing is by weight be sure to specify total, adjusted, or ideal body weight.
- When there are a range of doses it can be helpful to describe how the dose is chosen and/or give a 'typical' dose. When doses are repeated or a drug is given by infusion it can be helpful to describe titration intervals and increments.
+== Contraindications<!-- List contraindications and precautions for use of the drug. --> ==
-======Indication:======
+=== Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. --> ===
-*Route/Administration Dose Unit (weight qualifier) timing
+=== Precautions<!-- List precautions for use of the drug. If none, this section may be removed. --> ===
-======Induction of anesthesia:======
+== Pharmacology ==
-*IV over 30 to 60 seconds '''0.5 to 2 mg/kg''' (LBW)
+=== Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system --> ===
-**0.5 to 1 mg/kg in patients with shock
-*IM '''4 to 6 mg/kg'''
-======Maintenance of anesthesia (adjunct to TIVA or inhalational anesthesia)======
+==== Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. --> ====
-*'''0.25 to 0.35 mg/kg''' at incision, followed by continuous infusion '''up to 1 mg/kg/hour'''
+==== Adverse effects<!-- Describe any potential adverse effects of the drug. --> ====
-===Special Populations===
+=== Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. --> ===
+Metabolized by hepatic microsomal enzymes to norketamine via ''N''-demethylation. Norketamine is then metabolized to hydroxynorketamine. Ultimately, hydroxynorketamine undergoes glucuronide conjugation and is excreted in the urine.
-====Pediatrics====
+Norketamine has 33% of the potency of ketamine
-====Elderly====
+The plasma disappearance of ketamine is traditionally described by a two-compartment model.
-====Renal Impairment====
+Elimination half-life: 2.5-2.8 hr
-====Hepatic Impairment====
+Clearance: 12-17 mL/kg/min
-==Contraindications, Warnings, & Interactions<!-- List contraindications and precautions for use of the drug. -->==
-===Absolute contraindications<!-- List absolute contraindications for use of the drug. If none, this section may be removed. -->===
+Vd at steady state: 3.1 L/kg
-===Precautions<!-- List precautions for use of the drug. If none, this section may be removed. -->===
+== Chemistry and formulation<!-- Describe the chemistry and formulation of the drug. --> ==
-===Pregnancy & Breastfeeding<!-- If appropriate, give the drug's safety in pregnancy and for those breastfeeding -->===
+== History<!-- Describe the historical development of the drug. --> ==
-===Drug Interactions===
+== References ==
+Kamp J, Olofsen E, Henthorn TK, van Velzen M, Niesters M, Dahan A; Ketamine Pharmacokinetic Study Group. Ketamine Pharmacokinetics. Anesthesiology. 2020 Dec 1;133(6):1192-1213. doi: 10.1097/ALN.0000000000003577. PMID: 32997732.
-===Disease-Specific Concerns===
-==Adverse Effects==
-==Pharmacology==
-===Mechanism of action<!-- Describe the mechanism of action for the primary uses of the drug. -->===
-===Pharmacodynamics<!-- Describe the effects of the drug on the body. If appropriate, add subsections by organ system -->===
-===Pharmacokinetics<!-- Describe the pharmacokinetics of the drug. -->===
-==Further Resources==
- You can use this section to provide sources that offer further information that may be of interest to users. Present them as a bulleted list and give a brief description of the resource.
-==References==
+Miller, Ronald D. Miller's Anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone/Elsevier, 2010.
 [[Category:Drug reference]]
+[[Category:General anesthetics]]
+[[Category:Intravenous anesthetics]]
+[[Category:Sedative hypnotics]]
+[[Category:NMDA antagonists]]