Ketamine can provide sedation and analgesia while maintaining airway protection and respiratory drive. It is a paramedic-level medication that requires reporting to the medical director after each use. Ketamine works as a dissociative anesthetic and NMDA receptor antagonist with rapid onset of action between 60-90 seconds intravenously or 1-2 minutes intramuscularly and a duration of 10-15 minutes intravenously or 15-20 minutes intramuscularly. It is indicated for RSI, excited delirium, and facilitated extrication and has minimal respiratory depression, making it beneficial for patients with reactive airway disease.

1. Ketamine
Adam Frisch M.D.
For the
REMO Medical Advisory Committee

2. Background
• Ketamine can provide patients with sedation
and analgesia
• Patients can gain relief while still maintaining
airway protection and respiratory drive
• Paramedic level medication only
• Reporting from Medical Director required
after each use

3. Ketamine Hydrochloride
• Classification: Dissociative Anesthetic
– Sedative and analgesic properties
• Onset:
– 60-90 seconds - IV/IO
– 1-2 minutes - IM
• Duration of action:
– 10-15 minutes - IV/IO
– 15-20 minutes - IM

4. Pharmacology
• Mechanism of Action: Dissociation
Selectively disrupts association pathways of the
brain between thalamus and limbic system
– Competitive NMDA antagonist
• Ketamine is an ideal alternative to other
sedation medications because of its:
– Minimal respiratory depression
– Benefit with reactive airway disease

5. Indications / Contraindications
• Indications:
– RSI
– Excited Delirium
– Facilitated Extrication
– Adjunctive pain management (very low dose)
• Relative contraindications:
– Marked hypertension
– Marked tachycardia
– Cardiac ischemia

6. Specific information
• Supplied: (be aware of concentration)
– 100mg/mL
• Dosing:
– 1-2 mg/kg IV
– 3-5 mg/kg IM, may repeat once
• Pregnancy Category B

9. Must dilute for slow administration

10. Side Effects
• Apnea
– if rapid IV push
• Emergence reaction
• Hypersalivation
• General “uncomfortable feeling”
– In low, sub-dissociative doses
• Increased intraocular pressure
– Discuss risk/benefit with physician

11. Other
• Paramedic level administration only (no CCT)
• Physician order ONLY
• Consider benzodiazepine use with findings of
emergence phenomenon
– No need to pre-treat, however
• Consider atropine for management of
hypersalivation/secretions

12. Thanks.