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NMDA Receptor Antagonist (Dissociative Anaesthetic) Pregnancy: D

Ketamine (Burns Procedural Analgesia)

Brand names: Ketalar

Adult dose

Dose: 0.5–2 mg/kg IV for procedural analgesia; 0.5–1 mg/kg IV sub-dissociative for analgesia
Route: IV slow injection or infusion
Frequency: As needed for procedures
Max: 2 mg/kg for dissociative anaesthesia
Sub-dissociative dose (0.1–0.5 mg/kg): excellent for burns dressing changes without full anaesthesia; preserves airway reflexes; pre-medicate with midazolam 0.05–0.1 mg/kg to reduce emergence phenomena

Paediatric dose

Dose: 1 mg/kg
Route: IV
Frequency: single dose; repeat 50% of initial dose if needed
Max: 2 mg/kg IV
Concentration: 10 mg/mL, 50 mg/mL, 100 mg/mL mg/ml
Paediatric burns: 1–2 mg/kg IV or 4–6 mg/kg IM for dressing changes; pre-medicate with midazolam 0.05–0.1 mg/kg to prevent emergence phenomena; monitoring essential

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce dose in severe hepatic impairment (CYP3A4 metabolism)

Paediatric weight-based calculator

Paediatric burns: 1–2 mg/kg IV or 4–6 mg/kg IM for dressing changes; pre-medicate with midazolam 0.05–0.1 mg/kg to prevent emergence phenomena; monitoring essential

Clinical pearls

  • Uniquely provides analgesia, amnesia, and sedation while maintaining airway reflexes — ideal for burns dressing changes
  • Emergence phenomena: reduce by midazolam 0.05–0.1 mg/kg IV before ketamine; quiet recovery in dimly lit room
  • PAEDIATRIC DOSE TYPO CHECK: dose is mg/kg once — NOT mg/kg/kg

Contraindications

  • Severe hypertension
  • Acute MI
  • Psychiatric disorders (relative CI — emergence phenomena)
  • Raised intracranial pressure (may increase ICP)
  • Schizophrenia

Side effects

  • Emergence phenomena (hallucinations, vivid dreams — reduced by benzodiazepine pre-medication)
  • Hypertension
  • Tachycardia
  • Hypersalivation (atropine pre-treatment)
  • Laryngospasm (rare)
  • Nystagmus

Interactions

  • Benzodiazepines (reduce emergence phenomena)
  • Atropine (reduces hypersalivation)
  • CNS depressants (enhanced sedation)
  • Halothane (bradycardia)

Monitoring

  • Blood pressure
  • Heart rate
  • Oxygen saturation (SpO2)
  • Emergence reactions

Reference: BNFc; BNF 86; BBA guidelines; PERN study. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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