What is the recommended dose of ketamine (Ketamine) for sedation?

From the Guidelines

The recommended dose of ketamine for sedation is 0.75-2.0 mg/kg per dose.

Key Points

• Ketamine has a rapid onset of action (1 minute) and short duration of effect (10-30 minutes) 1.
• The standard dose range for ketamine is 0.75-2.0 mg/kg per dose, which has been shown to be effective for sedation in pediatric patients 1.
• Ketamine can be used in combination with midazolam to minimize emergence reactions, but the addition of midazolam does not decrease the incidence of recovery agitation 1.
• The use of ketamine for sedation has been studied predominantly in the pediatric setting, but it can also be useful as an adjunct to standard sedation for difficult-to-sedate adults 1.

Important Considerations

• Ketamine produces a dose-dependent increase in heart rate, blood pressure, and cardiac output, and its use should be avoided in patients with ischemic heart disease, cerebrovascular disease, or hypertension 1.
• Emergence reactions, such as floating sensations, vivid dreams, hallucinations, and delirium, have been reported in 10%-30% of adults, and the use of midazolam in combination with ketamine may help minimize this reaction 1.
• Ketamine has been shown to be safe and effective for sedation in pediatric patients, with a low rate of mild or severe behavioral reactions and good parental satisfaction 1.

From the FDA Drug Label

The ketamine hydrochloride injection dosage must be individualized and titrated to the desired clinical effect. If a longer duration of effect is desired, additional increments can be administered intravenously or intramuscularly to maintain anesthesia. Induction of Anesthesia Intravenous Route: 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.

The recommended dose of ketamine for sedation is not explicitly stated in the label, as the label provides dosing information for induction of anesthesia and maintenance of anesthesia.

• The initial dose for induction of anesthesia via the intravenous route ranges from 1 mg/kg to 4.5 mg/kg.
• The average amount required to produce 5 to 10 minutes of surgical anesthesia is 2 mg/kg 2. However, since the question is about sedation, and the label does not provide a direct answer to this question, a conservative clinical decision would be to consult other relevant resources for guidance on ketamine dosing for sedation.

From the Research

Recommended Dose of Ketamine for Sedation

The recommended dose of ketamine for sedation varies depending on the patient population and the specific procedure being performed.

• For pediatric patients, a dose of 1.5 mg/kg is commonly used for procedural sedation, as it requires fewer doses and has a lower overall mg/kg dosage compared to a dose of 1 mg/kg 3.
• However, lower doses of ketamine, such as 0.5-1.0 mg/kg, may also be effective for pediatric sedation, with 88% of patients being successfully sedated with 1 mg/kg or less 4.
• For adult patients, a dose of 0.5-1.0 mg/kg is often used for procedural sedation in the emergency department, with adequate sedation achieved in 98.9% of patients 5.
• In cases of severe agitation, a reduced-dose of 2 mg/kg intramuscular ketamine may be effective, particularly when used as a second-line agent 6.
• When combined with dexmedetomidine, a bolus dose of ketamine (1-2 mg/kg) may be used to initiate sedation, followed by a dexmedetomidine infusion and supplemental bolus doses of ketamine (0.5-1 mg/kg) as needed 7.