From the Guidelines
Ketamine dosing for sedation administered intravenously (IV) is typically in the range of 0.75-2.0 mg/kg.
Key Points
- The onset of action is rapid, within 1 minute, and the duration of effect is short, lasting 10-30 minutes 1.
- Ketamine has both analgesic and sedative properties, and it does not depress airway or cardiovascular reflexes, making it a useful option for sedation 1.
- The use of ketamine for endoscopic sedation has been studied predominantly in the pediatric setting, but it has also been useful as an adjunct to standard sedation for difficult-to-sedate adults 1.
- Common side effects of ketamine include emergence reactions, such as floating sensations, vivid dreams, hallucinations, and delirium, which can be minimized with the use of midazolam in combination with ketamine 1.
- Ketamine should be used with caution in patients with ischemic heart disease, cerebrovascular disease, or hypertension, as it can produce a dose-dependent increase in heart rate, blood pressure, and cardiac output 1.
Dosage Considerations
- The standard dose range for ketamine is 0.75-2.0 mg/kg per dose, which can be administered in combination with midazolam (0.05-0.2 mg/kg) for sedation 1.
- The dosage of ketamine may need to be adjusted based on the patient's response to the medication and their medical history.
- It is essential to monitor patients closely during and after ketamine administration to minimize the risk of adverse events.
From the FDA Drug Label
The initial dose of ketamine hydrochloride injection administered intravenously may range from 1 mg/kg to 4.5 mg/kg. The average amount required to produce 5 to 10 minutes of surgical anesthesia within 30 seconds following injection is 2 mg/kg. Ketamine hydrochloride injection given by slow microdrip infusion technique at a dose of 0.1 to 0.5 mg/minute will maintain general anesthesia in adult patients induced with ketamine hydrochloride injection.
The appropriate ketamine dosing for sedation administered intravenously (IV) is:
- Initial dose: 1 mg/kg to 4.5 mg/kg
- Average dose for 5-10 minutes of surgical anesthesia: 2 mg/kg
- Maintenance dose: 0.1 to 0.5 mg/minute by slow microdrip infusion technique 2
From the Research
Ketamine Dosing for Sedation
The appropriate ketamine dosing for sedation administered intravenously (IV) can vary depending on the specific context and patient population.
- In a study of adult patients receiving IV ketamine for burn wound care, the median ketamine dose administered was 1.2 mg/kg 3.
- A study of pediatric patients in the emergency department found that an initial bolus of 1.0 to 2.0 mg/kg IV ketamine was effective for sedation, with 1.5 mg/kg reliably producing adequate sedation in 94% of patients 4.
- In a randomized study of adult patients with acute agitation, ketamine was administered at a dose of 1 mg/kg IV, which was found to be effective for initial control of agitation 5.
- A review of ketamine dosing for depression noted that the drug is most commonly administered at a dose of 0.5 mg/kg, but some patients may respond to doses as low as 0.1 mg/kg or as high as 0.75 mg/kg 6.
- A study of mechanically ventilated adults receiving ketamine infusion for adjunct sedation found that the median dosage was 0.41 mg/kg/hour, with a range of 0.04-2.5 mg/kg/hr 7.
Key Considerations
When administering ketamine for sedation, it is essential to consider the following factors:
- Patient population: Different patient populations, such as adults or pediatric patients, may require different dosing regimens.
- Context: The specific context in which ketamine is being administered, such as burn wound care or acute agitation, may influence the appropriate dosing.
- Route of administration: Ketamine can be administered via various routes, including IV, intramuscular, or subcutaneous, which may affect the dosing regimen.
- Monitoring: Patients receiving ketamine should be closely monitored for adverse effects, such as hypertension, dysphoric reactions, or cardiopulmonary complications.