Ketamine
RSI induction, Procedural sedation, Acute pain management, Status epilepticus
Indications
- RSI induction
- Procedural sedation
- Acute pain management
- Status epilepticus
Adult dosing
- rsi: dose: 1.5; unit: mg/kg; route: IV; weightBased: true; maxDose: 200; maxDoseAbsolute: true; sedation: dose: 1; maxDose: 150; maxDoseAbsolute: true; unit: mg/kg; route: IV; weightBased: true; analgesia: dose: 0.3; unit: mg/kg; route: IV; weightBased: true; maxDose: 50; maxDoseAbsolute: true; im sedation: dose: 4; maxDose: 500; maxDoseAbsolute: true; unit: mg/kg; route: IM; weightBased: true
Pediatric dosing
- rsi: dose: 1.5; unit: mg/kg; route: IV; weightBased: true; maxDose: 200; maxDoseAbsolute: true; im sedation: dose: 4; maxDose: 500; maxDoseAbsolute: true; unit: mg/kg; route: IM; weightBased: true; analgesia: dose: 0.3; unit: mg/kg; route: IV; weightBased: true; maxDose: 50; maxDoseAbsolute: true; pedNote: Subdissociative dose
Contraindications
- Schizophrenia (relative)
- Aortic dissection (relative)
- Elevated ICP (relative — now largely reconsidered)
Clinical pearls
- Preferred induction agent in hemodynamically unstable patients
- Bronchodilator — excellent for asthmatic intubations
- Emergence reactions reduced with benzodiazepines (controversial)
- Dissociative dose for procedural sedation: 1-1.5 mg/kg IV over 60 sec
Source and review
- Roberts & Hedges' Clinical Procedures in Emergency Medicine, 7th ed.. Last reviewed: 2024-10-15