Diferencia entre revisiones de «Ketamine»

Sin resumen de edición
Sin resumen de edición
Línea 2: Línea 2:
===Absolute===
===Absolute===
#<3 mo old
#<3 mo old
#known or suspected schizophrenia (even if currently controlled)
#Known or suspected schizophrenia, even if currently stable or controlled w/ meds


===Relative===
===Relative===
#major procedures stipulating posterior pharynx (e.g. endoscopy)
#Major procedures involving posterior pharynx (e.g. endoscopy)
##(minor ED orophyarngeal procedures okay)
##Typical minor ED oropharyngeal procedures are okay
#airway instability (e.g. tracheal stenosis)
#Airway instability (e.g. tracheal stenosis, tracheal surgery)
#URI or active asthma (unless for induction)
#Active pulmonary infection, including URI or asthma (unless for induction)
#CAD, HTN, CHF (? >45 yr old; age cutoff not clearly defined)
#CAD, HTN, CHF
#CNS masses, hdocephalus (head trauma okay)
#CNS masses, hydrocephalus (head trauma okay)
#Glaucoma/acute globe (increased IOP)
#Glaucoma/acute globe injury
#Porphyria/thyroid (theoretical)
#Thyroid disorder or on thyroid medication


==Preparation==
==Preparation==
#Consent
#Monitor
#Monitor
#BVM/O2 mask (ready)
#BVM (ready)
#Suction (ready)
#Suction
#Ketamine (drawn up)
#Atropine (ready) [0.01 mg/kg IVP; min 0.1mg, max 0.5mg]
#Atropine (ready) [0.01 mg/kg IVP; min 0.1mg, max 0.5mg]
#Versed (ready) [0.05mg/kg IVP]
#Versed (ready) [0.05mg/kg IVP]
Línea 26: Línea 24:
==Administration==
==Administration==
#Give initial bolus
#Give initial bolus
##Children: 1.5-2 mg/kg SLOW IV* (over 1 min)
##Children: 1.5-2 mg/kg IV (over 30-60sec)
##Adults: 1 mg/kg SLOW IV* (over 1 min)
##Adults: 1 mg/kg IV (over 30-60sec)
##Nystagmus = effect
##Nystagmus = effect
##?maximal dose = 6mg/kg at one time
#May repeat boluses at 0.5-1 mg/kg increments
#May repeat boluses at 0.5-1 mg/kg increments
#IV prefered over IM
#IV prefered over IM (faster recovery, less emesis)
##IM dose 4-5 mg/kg in children (IM discouraged in adults)
##IM dose 4-5 mg/kg in children
###Repeat dose if sedation is inadequate after 5-10min or if additional doses required
==Side Effects==
*Airway misalignment requiring repositioning of head (occasional)
*Transient laryngospasm (0.3%)
*Transient apnea or respiratory depression (0.8%)
*Hypersalivation (rare)
*Emesis, usually well into recovery (8.4%)
*Recovery agitation (mild in 6.3%, clinically important in 1.4%)
*Muscular hypertonicity and random, purposeless movements (common)
*Clonus, hiccupping, or short-lived nonallergic rash of face and neck
 
 


==Side Effects==
#Transient rash (common)
##not harmful
#Hypersalvation (1.7%)
##may give atropine
##suction sides only
#Laryngospasm (<0.4%)
##not dose-dependent
##assoc with fast IVP
##assoc with procedures stimulating gag
#Transient apnea (<0.3%)
##around 2min after IVP
##normally BVM needed only
#Emergence Rx (~2% mod-severe)
##give benzo
#Emesis/persistent ataxia
##typically during recovery
##no cases of aspiration (airway reflex maintained)
##no driving!


==Overdose==
==Overdose==
Línea 58: Línea 48:


==Discharge Criteria==
==Discharge Criteria==
#Return to pretreatment verbalization/awareness
#Return to pretreatment level of verbalization/awareness
#Return to pretreatment muscular activity
#Return to pretreatment level of purposeful neuromuscular activity
 
#Do NOT have to wait until the pt can ambulate or tolerate PO
(NOT required to tolerate PO or ambulate; not recommended)


==See Also==
==See Also==
Línea 68: Línea 57:
==Source==
==Source==
Annals of EM. Clinical Practice Guideline for ED Ketamine Dissociative Sedation: 2011 Update
Annals of EM. Clinical Practice Guideline for ED Ketamine Dissociative Sedation: 2011 Update
[[Category:Drugs]]
[[Category:Drugs]]

Revisión del 22:29 10 jul 2011

Contraindications

Absolute

  1. <3 mo old
  2. Known or suspected schizophrenia, even if currently stable or controlled w/ meds

Relative

  1. Major procedures involving posterior pharynx (e.g. endoscopy)
    1. Typical minor ED oropharyngeal procedures are okay
  2. Airway instability (e.g. tracheal stenosis, tracheal surgery)
  3. Active pulmonary infection, including URI or asthma (unless for induction)
  4. CAD, HTN, CHF
  5. CNS masses, hydrocephalus (head trauma okay)
  6. Glaucoma/acute globe injury
  7. Thyroid disorder or on thyroid medication

Preparation

  1. Monitor
  2. BVM (ready)
  3. Suction
  4. Atropine (ready) [0.01 mg/kg IVP; min 0.1mg, max 0.5mg]
  5. Versed (ready) [0.05mg/kg IVP]
  6. "Happy Place"

Administration

  1. Give initial bolus
    1. Children: 1.5-2 mg/kg IV (over 30-60sec)
    2. Adults: 1 mg/kg IV (over 30-60sec)
    3. Nystagmus = effect
  2. May repeat boluses at 0.5-1 mg/kg increments
  3. IV prefered over IM (faster recovery, less emesis)
    1. IM dose 4-5 mg/kg in children
      1. Repeat dose if sedation is inadequate after 5-10min or if additional doses required

Side Effects

  • Airway misalignment requiring repositioning of head (occasional)
  • Transient laryngospasm (0.3%)
  • Transient apnea or respiratory depression (0.8%)
  • Hypersalivation (rare)
  • Emesis, usually well into recovery (8.4%)
  • Recovery agitation (mild in 6.3%, clinically important in 1.4%)
  • Muscular hypertonicity and random, purposeless movements (common)
  • Clonus, hiccupping, or short-lived nonallergic rash of face and neck



Overdose

Prolonged sedation --> full recovery

Discharge Criteria

  1. Return to pretreatment level of verbalization/awareness
  2. Return to pretreatment level of purposeful neuromuscular activity
  3. Do NOT have to wait until the pt can ambulate or tolerate PO

See Also

Procedural Sedation

Source

Annals of EM. Clinical Practice Guideline for ED Ketamine Dissociative Sedation: 2011 Update

Obtenido de «https://www.wikem.org/w/index.php?title=Ketamine&oldid=3601»