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Dissociative Anaesthetic (NMDA Receptor Antagonist) Pregnancy: Compatible — used in obstetric emergency anaesthesia; neonatal depression minimal at appropriate doses

Ketamine (Anaesthesia/Sedation)

Brand names: Ketalar

Adult dose

Dose: IV induction: 1–2 mg/kg IV. IM induction: 4–10 mg/kg IM. IV sedation/analgesia: 0.5–1 mg/kg IV. Infusion (ICU analgesia): 0.1–0.5 mg/kg/h.
Route: IV or IM
Frequency: Bolus or infusion
Max: 2 mg/kg IV for induction; titrate for infusion
Unique agent: maintains airway reflexes, bronchodilation (useful in asthma), haemodynamic stimulation. Dissociative states and hallucinations — co-administer benzodiazepine. Increases ICP — use with caution if raised ICP.

Paediatric dose

Dose: 1 mg/kg
Route: IV or IM
Frequency: Bolus PRN
Max: No fixed maximum — titrate to effect
Concentration: 10 mg/mL or 50 mg/mL mg/ml
Widely used in paediatric emergency anaesthesia and procedural sedation. Oral/intranasal sedation (using injectable solution): 5–10 mg/kg intranasally or orally for pre-medication. (IV (or 4–6 mg/kg IM)

Dose adjustments

Renal

No dose adjustment required

Hepatic

Caution in severe hepatic impairment — prolonged action

Paediatric weight-based calculator

Widely used in paediatric emergency anaesthesia and procedural sedation. Oral/intranasal sedation (using injectable solution): 5–10 mg/kg intranasally or orally for pre-medication. (IV (or 4–6 mg/kg IM)

Clinical pearls

  • Dissociative anaesthesia: eyes may remain open, patient appears awake but is unaware — counsel families
  • Airway reflexes relatively preserved — useful for difficult airway or when mask ventilation may be needed
  • Bronchodilator — drug of choice for asthmatic patient requiring anaesthetic induction
  • WHO Essential Medicines — particularly valuable in resource-limited settings due to IM route and self-preservation of airway

Contraindications

  • Uncontrolled hypertension (relative)
  • Previous dissociative/psychotic episodes (relative)
  • Raised ICP (use with caution; increased ICP is controversial — some evidence suggests not to withhold)

Side effects

  • Hallucinations and emergence reactions (reduce with benzodiazepine)
  • Tachycardia and hypertension
  • Increased oral secretions (glycopyrrolate prophylaxis in some protocols)
  • Nystagmus
  • Laryngospasm (rare)
  • Raised ICP (controversial)

Interactions

  • Benzodiazepines — reduce emergence reactions and prolong recovery (co-administer)
  • Atropine/glycopyrrolate — reduce secretions
  • Theophylline — potential seizures with co-administration
  • MAOIs — avoid

Monitoring

  • Blood pressure and heart rate (continuous)
  • SpO2
  • Signs of emergence reaction on recovery
  • Secretions

Reference: BNFc; BNF; Miller's Anaesthesia; WHO Model List of Essential Medicines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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