From the Guidelines
Ketamine should be administered at a dose of 1-2 mg/kg IV for intubation, as this dose range is supported by the most recent and highest quality evidence. This recommendation is based on the study by 1, which provides guidelines for the management of tracheal intubation in critically ill adults and suggests using ketamine at a dose of 1-2 mg/kg in shock states. Additionally, the study by 1 supports the use of ketamine at a dose of 1-2 mg/kg for rapid sequence intubation in critically ill adult patients.
The IV route is preferred for rapid sequence intubation due to its faster onset of action compared to IM administration. When using ketamine for intubation, it's essential to be aware that it can cause increased secretions, so pretreatment with an antisialagogue like glycopyrrolate or atropine may be beneficial. Ketamine is particularly useful in hemodynamically unstable patients as it generally preserves or even increases blood pressure and heart rate through sympathomimetic effects.
Some key points to consider when using ketamine for intubation include:
- Ketamine provides both sedation and analgesia, making it effective for intubation
- It should be used with caution in patients with severe hypertension, increased intracranial pressure, or coronary artery disease due to its cardiovascular stimulatory effects
- The drug works by acting as an NMDA receptor antagonist, creating a dissociative anesthetic state while maintaining airway reflexes and respiratory drive better than many other induction agents
- Recent studies, such as 1 and 1, have evaluated the use of ketamine for intubation and support its effectiveness and safety in critically ill patients.
Overall, the use of ketamine at a dose of 1-2 mg/kg IV for intubation is supported by the most recent and highest quality evidence, and it should be considered a viable option for rapid sequence intubation in critically ill adult patients.
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 dosage for ketamine for intubation is 1 mg/kg to 4.5 mg/kg intravenously, with an average dose of 2 mg/kg to produce 5 to 10 minutes of surgical anesthesia. The dose should be administered slowly over a period of 60 seconds 2.
From the Research
Dosage for Ketamine in Intubation
The typical dosage of ketamine for rapid sequence intubation (RSI) is:
- 1 to 2 mg/kg intravenously 3
- Some studies have used higher doses, but this is associated with increased odds of adverse events such as hypotension, laryngospasm, and bradycardia 3, 4
Comparison with Other Studies
Other studies have used different dosages, such as:
- 0.75 mg/kg ketamine with 1 mg/kg propofol for induction of anesthesia in elderly patients 5
- The dosage of ketamine used in these studies varied, but the typical range is between 1 to 2 mg/kg 6, 4, 7
Adverse Events
Adverse events associated with ketamine dosage for intubation include: