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Discussion

Ketamine

Hey all!

Anyone have any literature on Ketamine gtts?

We don't use them too often, (I've probably administered it 3 times in 3.5 years) usually as a last resort for people in status. Anyway, there is next to no literature on it....even on how it works on the cellular level. The pharmacy didn't even have anything the last time I asked. I'd like to have a reputable article so that I can add it to our stuff on the unit. I keep meaning to ask one of the neurologists for something, but never have gotten around to it.

When you try to find stuff on the internet, it just brings it up as a horse tranquilizer, because that's all it's mainly used for now. I know it's old school, but I'll tell ya, when you've run out of all the other options, it's the bomb!!

I was hoping someone had some kind of article....perhaps the other Neuro queen, Gwenith???? :)

Thanks!

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  • Experts

You might get some good answers in MICU forum simply because it is still used as a drug of last resort for Status Asthmaticus.

I found this article on Status Asthmaticus and ketamine and it includes what HAS to be the "quote of the week"

"Kitchen sink" therapies include magnesium, helium, ketamine, antibiotics, inhalational anesthetics, aerosolized lasix.

Love the term "Kitchen sink therapies":p

but it goes on to add


  1. Ketamine
  2. Ketamine is a dissociative anesthetic which has the useful property of producing bronchodilation.
  3. It produces less (but not zero) respiratory depression than most other anesthetics.
  4. Ketamine produces increased sympathetic tone, hence generally there is preservation of blood pressure. It is an intrinsic myocardial depressant, however, so there may be myocardial depression if the patient sympathetic stores have been depleted.
  5. Other side effects include increased secretions and emergence phenomena (hallucinations upon emergence).
  6. Ketamine is used most frequently for induction of anesthesia when intubating asthmatics. Occasionally it has been used, with caution, in unintubated asthmatics, for its bronchodilatory properties.
  7. Usual dose is 0.5-1.0 mg/kg. Continuous infusion 0.5-1.0 mg/kg/hour, titrated carefully to effect (sedation and bronchodilation).

    8. OHSU Peds Teaching Files - Status Asthmaticus

    We recently used Propofol with good effect on a status epilepticus so any info you have on Ketamine would be appreciated.

    In the meantime I will see what I can dig up for you on Ketamine


  • Experts

A Case Presentation and Literature Review of Successful Ketamine Administration in a Patient with Refractory Status Asthmaticus

http://professionals.epilepsy.com/pdfs/mayoclinic%20pdf.pdf

This article does not say much about Ketamine but does offer some reasoned plans for treatment of status epilepticus including the use of propofol

Treatment Strategies for Status Epilepticus

Some points in this one to ponder

Critical Care | Full text | Prolonged refractory status epilepticus following acute traumatic brain injury: a case report of excellent neurological recovery

Will keep looking

"Dissociative" is putting it mildly. Everyone I've ever seen get ketamine has turned into a screaming banshee. It scares the heck out of the rest of th patients. I can't imagine having someone on a continuous drip. :uhoh21:

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