From the Guidelines
The recommended dose of ketamine for analgesia and sedation is 0.1 to 0.5 mg/kg intravenously (IV) or 1 to 2 mg/kg intramuscularly (IM), administered over a period of 1 to 2 minutes, as supported by studies such as 1.
Key Considerations
- For procedural sedation, a dose of 1 to 2 mg/kg IV or 2 to 4 mg/kg IM is typically used, with a duration of effect ranging from 15 to 60 minutes 1.
- In cases of severe pain or agitation, a continuous infusion of 0.1 to 0.5 mg/kg/hour may be considered, with close monitoring of vital signs and clinical response 1.
- The use of ketamine in combination with other agents, such as midazolam, may be effective for procedural sedation, as shown in studies such as 1.
- The safety and efficacy of ketamine have been demonstrated in various studies, including those in pediatric patients 1 and elderly patients 1.
Important Safety Information
- Ketamine can cause psycho-perceptual adverse effects, such as hallucinations and dissociation, especially at higher doses 1.
- Monitoring of vital signs and clinical response is crucial when using ketamine, especially in patients with cardiovascular disease or other comorbidities 1.
- The use of ketamine in patients with a history of substance abuse or psychiatric disorders should be approached with caution, as it may exacerbate these conditions 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. However, a higher total dose will result in a longer time to complete recovery 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. Intramuscular Route: The initial dose of ketamine hydrochloride injection administered intramuscularly may range from 6.5 to 13 mg/kg. A dose of 9 to 13 mg/kg usually produces surgical anesthesia within 3 to 4 minutes following injection, with the anesthetic effect usually lasting 12 to 25 minutes.
The dose for ketamine is:
- Intravenous Route: 1 mg/kg to 4.5 mg/kg, with an average of 2 mg/kg to produce 5 to 10 minutes of surgical anesthesia
- Intramuscular Route: 6.5 to 13 mg/kg, with 9 to 13 mg/kg usually producing surgical anesthesia within 3 to 4 minutes 2 3
From the Research
Ketamine Dosage
The dosage of ketamine varies depending on the intended use and patient population.
- For analgesia in the emergency department, low-dose ketamine (LDK) is defined as 0.1 to 0.6 mg/kg 4.
- A study on ketamine for depression found that the most common dose is 0.5 mg/kg, but some patients may respond to doses as low as 0.1 mg/kg or require up to 0.75 mg/kg 5.
- For acute pain in the emergency department, a retrospective cohort study found that low-dose ketamine (<0.3 mg/kg) is an effective and safe pain management strategy 6.
- In children with sickle cell disease, a randomized controlled trial found that 1 mg/kg of intravenous ketamine is non-inferior to intravenous morphine 0.1 mg/kg for severe painful sickle cell crisis 7.
- For rapid sedation of agitated patients, a systematic review and proportional meta-analysis found that the mean dose of ketamine was 315 mg (SD 52) given intramuscularly 8.
Administration Routes
Ketamine can be administered through various routes, including:
- Intravenous (IV) 4, 6, 7
- Intramuscular (IM) 4, 8
- Subcutaneous 5
- Oral 5
- Sublingual 5
- Transmucosal 5
- Intranasal 5
Dosing Considerations
The optimal dose of ketamine may depend on various factors, including the patient's weight, age, and medical condition.