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Ketamine  
Ketamine is an anesthetic medication. Ketamine is used to put you to sleep for surgery and to prevent pain and discomfort during certain medical tests or procedures. Ketamine may also be used for purposes not listed in this medication guide. What is the most important information I should know about...
Ketamine is used for.Inducing anesthesia (lack of sensation or feeling) before surgery or certain procedures that do not require skeletal muscle relaxation. It may also be used for other conditions as determined by your doctor.Ketamine is an anesthetic. It works in the brain to inhibit painful sensations.​
Before using ketamine:Some medical conditions may interact with ketamine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
if you are pregnant, planning to become pregnant, or are breast-feedingif you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplementif you have allergies to medicines, foods, or other substancesif you have a history of head trauma or injury, bleeding in the brain, a stroke, increased spinal fluid pressure, increased pressure in the eye, bladder or urinary problems, heart problems (eg, congestive heart failure), high blood pressure, mental or mood problems, or thyroid problemsif you have a history of alcoholism or you are intoxicated by alcohol
Some MEDICINES MAY INTERACT with ketamine. Tell your health care provider if you are taking any other medicines, especially any of the following:Amiodarone or droxidopa because serious side effects, such as abnormal heart rhythms, may occur
This may not be a complete list of all interactions that may occur. Ask your health care provider if ketamine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
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                                                                                                               How to use ketamine:
Use ketamine as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Ketamine is usually administered as an injection at your doctor's office, hospital, or clinic by those experienced in administering general anesthetics, in maintaining an airway, and in controlling respiration.Do not use ketamine if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.If you miss a dose of ketamine, contact your doctor right away.
Ask your health care provider any questions you may have about how to use ketamine.
                                                                                                        Important safety information:
Ketamine may cause drowsiness for up to 24 hours. These effects may be worse if you take it with alcohol or certain medicines. Use ketamine with caution. Do not drive or perform other possibly unsafe tasks for at least 24 hours following surgery until you know how you react to it.Ketamine may cause behavior, mental, or mood changes; confusion; or hallucinations that usually go away within 24 hours. Discuss any questions or concerns with your doctor.Tell your doctor or dentist that you take ketamine before you receive any medical or dental care, emergency care, or surgery.Use ketamine with caution in the ELDERLY; they may be more sensitive to its effects.Ketamine should be used with extreme caution in CHILDREN younger than 16 years old; safety and effectiveness in these children have not been confirmed.PREGNANCY and BREAST-FEEDING: It is not known if ketamine can cause harm to the fetus. Use of ketamine during pregnancy is not recommended. If you are or will be breast-feeding while you are using ketamine, check with your doctor or pharmacist to discuss the risks to your baby.
                                                                                                            Possible side effects of ketamine:
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Loss of appetite; nausea; vomiting.Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); behavior changes; confusion; difficult, frequent, or painful urination; double vision; fainting; fast, slow, or irregular heartbeat; hallucinations; involuntary muscle movements; mental or mood changes (eg, anxiety); pain, redness, or swelling at the injection site; severe or persistent dizziness, light-headedness, or headache; slowed or shallow breathing; uncontrolled eye movements.
This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency
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                                                                                                                Usual Adult Dose for Anesthesia
Parenteral:
  • Intravenous:
  • Induction: 1 to 4.5 mg/kg; alternatively, 1 to 2 mg/kg at a rate of 0.5 mg/kg/min may be used. (2 mg/kg dose provides 5 to 10 minutes of surgical anesthesia within 30 seconds following injection).
  • Maintenance: The maintenance dose should be adjusted according to the patient's anesthetic needs and whether an additional anesthetic is employed. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia.
  • Intramuscular:
  • Induction: 6.5 to 13 mg/kg; (9 to 13 mg/kg dose provides 12 to 25 minutes of surgical anesthesia within 3 to 4 minutes following injection).
  • Maintenance: The maintenance dose should be adjusted according to the patient's anesthetic needs and whether an additional anesthetic is employed. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia.
  • Renal Dose Adjustments
  • Data not available
  • Liver Dose Adjustments
  • Data not available
  • Dose Adjustments
As with other general anesthetic agents, the individual response to ketamine is somewhat varied depending on the dose, route of administration, and age of patient, so that the dosage recommendation cannot be absolutely fixed. The drug should be titrated against the patient's requirements. Diazepam (2 to 5 mg over 60 seconds), administered in a separate syringe, may be used along with ketamine IV infusion for induction or maintenance of anesthesia. In most cases, 15 mg of IV diazepam or less will suffice.
Adult patients induced with ketamine augmented with IV diazepam may be maintained on ketamine given by slow microdrip infusion technique at a dose of 0.1 to 0.5 mg/min, augmented with diazepam 2 to 5 mg administered IV as needed. In many cases, 20 mg or less of IV diazepam total for combined induction and maintenance will suffice. However, slightly more diazepam may be required depending on the nature and duration of the operation, physical status of the patient, and other factors. The incidence of psychological manifestations during emergence, particularly dream-like observations and emergence delirium, may be reduced by this maintenance dosage program.
Precautions.Elevation of blood pressure begins shortly after injection of ketamine, reaches a maximum within a few minutes and usually returns to preanesthetic values within 15 minutes after injection. In the majority of cases, the systolic and diastolic blood pressure peaks from 10 to 50 % above preanesthetic levels shortly after induction of anesthesia, but the elevation can be higher or longer in individual cases.
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Ketamine Hydrochloride Injection, USP
CIII
SPECIAL NOTE
EMERGENCE REACTIONS HAVE OCCURRED IN APPROXIMATELY 12 PERCENT OF PATIENTS.
THE PSYCHOLOGICAL MANIFESTATIONS VARY IN SEVERITY BETWEEN PLEASANT DREAM-LIKE STATES, VIVID IMAGERY, HALLUCINATIONS, AND EMERGENCE DELIRIUM. IN SOME CASES THESE STATES HAVE BEEN ACCOMPANIED BY CONFUSION, EXCITEMENT, AND IRRATIONAL BEHAVIOR WHICH A FEW PATIENTS RECALL AS AN UNPLEASANT EXPERIENCE. THE DURATION ORDINARILY IS NO MORE THAN A FEW HOURS; IN A FEW CASES, HOWEVER, RECURRENCES HAVE TAKEN PLACE UP TO 24 HOURS POSTOPERATIVELY. NO RESIDUAL PSYCHOLOGICAL EFFECTS ARE KNOWN TO HAVE RESULTED FROM USE OF KETAMINE HYDROCHLORIDE INJECTION.
THE INCIDENCE OF THESE EMERGENCE PHENOMENA IS LEAST IN THE ELDERLY (OVER 65 YEARS OF AGE) PATIENT. ALSO, THEY ARE LESS FREQUENT WHEN THE DRUG IS GIVEN INTRAMUSCULARLY AND THE INCIDENCE IS REDUCED AS EXPERIENCE WITH THE DRUG IS GAINED.
THE INCIDENCE OF PSYCHOLOGICAL MANIFESTATIONS DURING EMERGENCE, PARTICULARLY DREAM-LIKE OBSERVATIONS AND EMERGENCE DELIRIUM, MAY BE REDUCED BY USING LOWER RECOMMENDED DOSAGES OF KETAMINE HYDROCHLORIDE INJECTION IN CONJUNCTION WITH INTRAVENOUS DIAZEPAM DURING INDUCTION AND MAINTENANCE OF ANESTHESIA. (SeeDOSAGE AND ADMINISTRATION Section.) ALSO, THESE REACTIONS MAY BE REDUCED IF VERBAL, TACTILE, AND VISUAL STIMULATION OF THE PATIENT IS MINIMIZED DURING THE RECOVERY PERIOD. THIS DOES NOT PRECLUDE THE MONITORING OF VITAL SIGNS.
IN ORDER TO TERMINATE A SEVERE EMERGENCE REACTION, THE USE OF A SMALL HYPNOTIC DOSE OF A SHORT-ACTING OR ULTRA SHORT-ACTING BARBITURATE MAY BE REQUIRED.
WHEN KETAMINE HYDROCHLORIDE INJECTION IS USED ON AN OUTPATIENT BASIS, THE PATIENT SHOULD NOT BE RELEASED UNTIL RECOVERY FROM ANESTHESIA IS COMPLETE AND THEN SHOULD BE ACCOMPANIED BY A RESPONSIBLE ADULT.
Ketamine Injection Description
Ketamine hydrochloride is a nonbarbiturate anesthetic chemically designated dl 2-(0-chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride. It is formulated as a slightly acid (pH 3.5-5.5) sterile solution for intravenous or intramuscular injection in concentrations containing the equivalent of either 10, 50 or 100 mg ketamine base per milliliter and contains not more than 0.1 mg/mL Phemerol® (benzethonium chloride) added as a preservative. The 10 mg/mL solution has been made isotonic with sodium chloride.
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Proper storage of ketamine:Ketamine is usually handled and stored by a health care provider. Keep ketamine out of the reach of children and away from pets.
General information:
If you have any questions about ketamine, please talk with your doctor, pharmacist, or other health care provider.Ketamine is to be used only by the patient for whom it is prescribed. Do not share it with other people.If your symptoms do not improve or if they become worse, check with your doctor.Check with your pharmacist about how to dispose of unused medicine.
This information should not be used to decide whether or not to take ketamine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about ketamine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to ketamine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using ketamine.
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