Anesthetics:
Indications for KETALAR:
As the sole anesthetic agent for diagnostic and surgical procedures not requiring skeletal muscle relaxation. Induction prior to other general anesthesia. Supplement to other anesthetic agents.
Adults and Children:
<16yrs: not established. Administer an antisialagogue prior to induction. Individualize. Give by slow IV inj over 60secs. ≥16yrs: IV induction: initial range: 1–4.5mg/kg; usually 2mg/kg to produce 5–10mins surgical anesthesia. Alternatively, 1–2mg/kg at rate of 0.5mg/kg/min may be used. In addition, diazepam 2–5mg doses given in separate syringe over 60secs, may be used. IM induction: initial range: 6.5–13mg/kg; usually 10mg/kg to produce 12–25mins surgical anesthesia. Usual range: 9–13mg/kg IM to produce surgical anesthesia within 3–4mins following inj, with effects lasting 12–25mins. Maintenance: repeat as needed in increments of 1/2 to full induction dose; see full labeling. Supplement to other anesthetics: can use a regimen of reduced ketamine dose with diazepam plus other combinations.
Contraindications:
Significant hypertension.
Warnings/Precautions:
To be administered under the supervision of experienced clinicians. Have resuscitative equipment available. Avoid monotherapy and/or mechanical stimulation in pharynx, larynx or bronchial tree surgery/diagnostic procedures; may require muscle relaxants. Hypertensive or cardiac decompensated; monitor cardiac function. Obtain baseline LFTs (including alkaline phosphatase, gamma glutamyl transferase). Monitor for psychological manifestations post-op. Preanesthetic elevated cerebrospinal fluid pressure. Alcoholics, drug abusers. Abuse potential. Pediatric neurotoxicity risk with repeated or prolonged use. Elderly. Labor & delivery, pregnancy: not recommended.
Pharmacologic Class:
NMDA receptor antagonist.
Interactions:
Concomitant theophylline or aminophylline may lower the seizure threshold; consider alternatives. Monitor closely with sympathomimetics or vasopressin; consider dose adjustment. Increased sedation, respiratory depression, coma, death with concomitant opioid analgesics, benzodiazepines, or other CNS depressants (including alcohol); monitor. Concomitant opioid analgesics may prolong recovery time.
Adverse Reactions:
Hyper- or hypotension, bradycardia, arrhythmia, respiratory depression (may be severe; esp. with rapid IV or high-doses), apnea, laryngospasms, airway obstruction, diplopia, nystagmus, intraocular pressure, urinary tract and bladder symptoms, cystitis, hydronephrosis, reduced bladder capacity, tonic/clonic movements, anorexia, GI upset, anaphylaxis, inj site pain, exanthema, transient erythema, rash; emergence reactions (eg, pleasant dream-like states, hallucinations, delirium, confusion, excitement, irrational behavior), elevated cerebrospinal fluid pressure, drug-induced liver injury.
Generic Availability:
YES
How Supplied:
Multi-dose vials (5mL, 10mL, 20mL)—10
