Ketamine

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Ketamine
Trade names

Ketalar

Ketamine.svg
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

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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.