From the Guidelines
The recommended dose of ketamine for procedural sedation is 0.5-1 mg/kg IV, with a maximum dose of 2 mg/kg. This dose range is supported by the study by Green et al 1, which found that an initial IM dose of 4 mg/kg with repeat doses of 2-4 mg/kg was effective and safe in children. However, for IV administration, lower doses are typically used. The study by Aggarwal et al, as cited in the review by the AGA Institute 1, also supports the use of ketamine for procedural sedation, with a dose range of 0.75-2.0 mg/kg per dose.
When administering ketamine, it is essential to consider the potential side effects, including:
- Increased blood pressure and heart rate
- Hallucinations and emergence reactions
- Respiratory depression at higher doses
To minimize the risk of adverse events, ketamine should only be administered by healthcare professionals with appropriate monitoring equipment and resuscitation capabilities. The medication should be used cautiously in patients with:
- Cardiovascular disease
- Increased intracranial pressure
- Psychiatric disorders
In terms of specific dosing, the following guidelines can be followed:
- For anesthesia induction, a dose of 1-2 mg/kg IV can be used
- For pain management, a dose of 0.1-0.5 mg/kg IV can be used
- For treatment-resistant depression, a dose of 0.5 mg/kg IV infused over 40 minutes can be used
- For intramuscular administration, a dose of 4-5 mg/kg can be used
It is crucial to note that the dose of ketamine should be individualized based on the patient's specific needs and medical history. Additionally, the use of midazolam in combination with ketamine can help minimize the risk of emergence reactions 1.
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. The induction dose may be administered as an intravenous infusion at a rate of 0.5 mg/kg/min. The initial dose of ketamine hydrochloride injection administered intramuscularly may range from 6.5 to 13 mg/kg.
The recommended dose of ketamine is:
- Intravenous route: 1 mg/kg to 4.5 mg/kg, with an average dose of 2 mg/kg to produce 5 to 10 minutes of surgical anesthesia.
- Intramuscular route: 6.5 to 13 mg/kg. The dose should be individualized and titrated to the desired clinical effect 2.
From the Research
Ketamine Dosage
- The dosage of ketamine varies depending on the clinical application, ranging from anesthetic induction and maintenance to analgesic and sedative effects 3.
- Subanesthetic doses of ketamine are used for acute and chronic pain management, as well as depression 3, 4.
- The subanesthetic dosage range for acute pain management is supported by evidence, although larger studies are needed to determine optimal treatment parameters 5.
Administration Routes
- Ketamine can be administered via multiple routes, including oral, nasal, rectal, intravenous, intramuscular, subcutaneous, transdermal, sublingual, and intraosseous 3.
- Intravenous ketamine infusion is a safe and effective acute pain management modality for moderate to severely painful surgical procedures 6.
Clinical Applications
- Ketamine is beneficial in clinical settings ranging from procedural sedation to the treatment of chronic pain 4.
- Ketamine has been used for decades to treat acute pain, and its usage has increased in emergency departments, perioperative periods, and in opioid-tolerant patients 5.
- Ketamine may be particularly beneficial in the management of burn patients, who often require multiple procedures over the course of their treatment 7.