What is the recommended dosing regimen for a ketamine (ketamine hydrochloride) drip for sedation or pain management?

Ketamine Drip Dosing Regimen for Sedation and Pain Management

For sedation and pain management, ketamine should be administered at 0.5 mg/kg IV bolus followed by a continuous infusion of 0.1-0.2 mg/kg/hr (maximum 0.4 mg/kg/hr) when used as an adjunct to opioid therapy. 1

Dosing Recommendations by Clinical Context

ICU Pain Management

• Initial bolus: 0.5 mg/kg IV push
• Continuous infusion: 1-2 μg/kg/min (0.06-0.12 mg/kg/hr)
• Maximum rate: 0.4 mg/kg/hr 1

Procedural Sedation

• Adult dosing: 0.5-1.0 mg/kg IV 2
• Pediatric dosing: Higher mg/kg doses than adults, titrated to lowest effective dose 2
• Induction of anesthesia: 1-4.5 mg/kg IV (average 2 mg/kg) administered slowly over 60 seconds 3
• Maintenance of anesthesia: 0.1-0.5 mg/min by slow microdrip infusion technique 3

Postoperative Pain

• Bolus dose: 0.5 mg/kg IV
• Infusion rate: 0.1-0.2 mg/kg/hr 1
• Duration: Up to 24-72 hours for optimal effect 1

Administration Guidelines

IV Administration

1. Dilution requirements:

   • 100 mg/mL concentration must be diluted before IV administration
   • Dilute with equal volume of Sterile Water, 0.9% Sodium Chloride, or 5% Dextrose 3
   • For maintenance infusion (1 mg/mL): Transfer 10 mL from 50 mg/mL vial to 500 mL of 5% Dextrose or 0.9% Sodium Chloride 3

2. Rate of administration:

   • Administer bolus doses slowly (over 60 seconds)
   • Rapid administration may cause respiratory depression and enhanced vasopressor response 3

Monitoring Requirements

• Continuous monitoring of vital signs including:
  • Pulse oximetry
  • Heart rate
  • Blood pressure
  • Consider capnography for moderate to deep sedation 2
• Emergency airway equipment must be immediately available 3

Special Considerations

Adjunctive Medications

• Consider administering an antisialagogue prior to ketamine administration to reduce salivation 3
• Consider benzodiazepine co-administration to reduce emergence reactions, particularly for longer procedures 3

Efficacy Benefits

• Ketamine reduces opioid consumption in postoperative and ICU settings 1
• Low-dose ketamine (0.5 mg/kg) combined with propofol results in:
  • Shorter recovery times (17 vs 22 minutes)
  • Lower total propofol requirements (0.28 vs 0.40 mg/kg/min) 4

Safety Considerations

• Monitor for potential adverse effects:
  • Respiratory depression (rare at recommended doses)
  • Emergence reactions (more common in adults than children)
  • Nausea/vomiting (occurs in approximately 7-19% of cases) 2
  • Hypotension with IV administration (monitor closely) 1
• Genitourinary pain has been reported with chronic ketamine use 3

Dosing Algorithm

1. For ICU pain management:

   • Start with 0.5 mg/kg IV bolus
   • Follow with 1-2 μg/kg/min continuous infusion
   • Assess pain control after 30 minutes
   • If inadequate, increase to maximum of 0.4 mg/kg/hr

2. For procedural sedation:

   • Adults: Begin with 0.5 mg/kg IV
   • Pediatrics: Consider starting at 0.5-1.0 mg/kg IV 5
   • Titrate with additional doses of 0.25-0.5 mg/kg as needed
   • Most pediatric patients can be successfully sedated with 1 mg/kg or less 5

3. For postoperative pain:

   • Administer 0.5 mg/kg IV bolus
   • Follow with 0.1-0.2 mg/kg/hr infusion
   • Continue for 24-72 hours as needed

Ketamine's unique mechanism as an NMDA receptor antagonist makes it particularly valuable for reducing opioid tolerance and hyperalgesia while providing effective analgesia and sedation across multiple clinical scenarios 1.