Ketamine is a dissociative anesthetic that works by binding NMDA receptors. It is commonly used for procedural sedation that provides sedation, analgesia, and amnesia, while maintaining protective airway reflexes and breathing, making it suitable for numerous procedures such as wound repairs (lacerations, burns, fractures).

Initial Dose: 1 - 1.5 mg/kg | PRN Dose: 0.5 - 1 mg/kg q5-10 min | Max Total dose 5 mg/kg

Advantages:

Disadvantages:

Relative Contraindications:

• Conditions worsened by an increase in blood pressure or heart rate, such as poorly controlled high blood pressure.

• Psychiatric disorders: Ketamine may exacerbate the symptoms of certain psychiatric disorders.

• Penetrating eye injury/Raised intraocular pressure (IOP): Ketamine can further increase IOP
  

Sedation Checklist:

1. Assess the patient for any potential contraindications/side effects to ketamine or prior personal or familial adverse reactions to anesthesia. If concerning history or abnormalities on the exam (ie high ASA, difficult airway, cardiac hx, etx), consider consulting anesthesia prior to procedural sedation.

2. Ensure that room is set up appropriately with BVM, ETCO2, oxygen, and suction. During the procedure, continuous monitoring of vital signs, such as blood pressure, heart rate, and oxygen saturation, is necessary.

3. Check to make sure Zofran and all ketamine doses are ordered appropriately.