IV Ketamine Push Rate Recommendations
The recommended push rate for intravenous (IV) ketamine is administration over 60 seconds to minimize respiratory depression and enhanced vasopressor response. 1
Dosing and Administration Guidelines
FDA-Approved Administration Rate
- Ketamine should be administered slowly (over a period of 60 seconds) when given as an IV push 1
- Rapid administration may result in respiratory depression and enhanced vasopressor response 1
Alternative Administration Methods
- For induction of anesthesia: ketamine can be administered as an IV infusion at 0.5 mg/kg/min 1
- For procedural sedation: slow infusion over 15 minutes has been shown to reduce psychoperceptual side effects compared to 1-minute IV push 2
Dosing Considerations by Clinical Context
For Anesthesia Induction
- Initial IV dose: 1-4.5 mg/kg (average 2 mg/kg) 1
- Duration of action: 5-10 minutes following IV administration 1
For Pain Management in Critical Care
- Low-dose ketamine (0.5 mg/kg IV push followed by 1-2 μg/kg/min infusion) is recommended as an adjunct to opioid therapy 3
- For breakthrough pain in PACU: 0.5 mg/kg ketamine titrated to effect 3
For Pediatric Sedation
- Initial dose: 1-1.5 mg/kg IV with onset of action in 1-2 minutes 4
- Lower doses (0.5-1.0 mg/kg) may be effective for procedural sedation in children 5
Safety Considerations
Monitoring Requirements
- Continuous monitoring of vital signs is essential during ketamine administration 1
- Pulse oximetry, heart rate, and blood pressure monitoring every 5 minutes 4
- Emergency airway equipment must be immediately available 1
Adverse Effects Related to Push Rate
- Slow infusion (15 minutes) versus IV push (1 minute) significantly reduces moderate-to-severe psychoperceptual side effects (43.4% vs 75.9%) and hallucinations (6.7% vs 27.6%) 2
- Rapid administration increases risk of respiratory depression and vasopressor response 1
Special Populations
High-Risk Patients
- For ASA class III and IV patients, the ED50 for ketamine is 0.9 mg/kg and ED95 is 1.6 mg/kg for abolition of response to verbal commands 6
- Ketamine increases systolic blood pressure, diastolic blood pressure, and heart rate in these patients 6
Clinical Pearls
- Ketamine must be diluted properly before IV administration - the 100 mg/mL concentration should not be injected without dilution 1
- Dilute with equal volume of either Sterile Water for injection, 0.9% Sodium Chloride, or 5% Dextrose in Water 1
- Use immediately after dilution 1
- Consider administering an antisialagogue prior to ketamine administration due to potential for salivation 1
By adhering to the recommended push rate of 60 seconds for IV ketamine administration, clinicians can minimize adverse effects while maintaining efficacy across various clinical scenarios.