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.
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.
<16yrs: not established.
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. Drug-induced liver injury. 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.
NMDA receptor antagonist.
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.
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, biliary duct dilatation w/wo biliary obstruction (with recurrent use).
Generic Drug Availability:
Multi-dose vials (5mL, 10mL, 20mL)—10