Sedation, analgesia and paralysis
Ketamine (Ketalar) drip
Ketalar
Dosing
| Start | Analgesia 0.1–0.3 mg/kg/h (sub-dissociative); sedation 0.5–2 mg/kg/h |
|---|---|
| Titrate | By 0.05–0.1 mg/kg/h for analgesia, to effect for sedation |
| Maximum | Analgesia about 0.5 mg/kg/h; refractory status epilepticus may need more |
| Common bags | 250 mg in 250 mL (1 mg/mL); 500 mg in 100 mL (5 mg/mL) |
| Dose units | mg/kg/h |
Line and administration
- Peripheral or central
Watch for
- Emergence reactions (lower with concurrent sedation)
- Hypertension and tachycardia; hypersalivation
- Liver enzyme rise with prolonged infusion
Ketamine: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Airway and RSIRSI drugs: Ketamine: 1–2 mg/kg: About 30 s: Raises HR, BP; bronchodilates; emergence
- Asthma and COPD ExacerbationsVentilating obstructed lungs: Ketamine is a useful induction drug in asthma (bronchodilates)
- Sedation, Pain and Delirium ScalesWhy analgesia-first light sedation: Pain: Low-dose ketamine adjunct after surgery: Conditional
- Mental Health: Meds and CommunicationStimulant toxicity: AHA 2023 recommends sedation for severe agitation, naming benzodiazepines, antipsychotics and ketamine, and rates prolonged physical restraint without sedation as harmful; AHA 2025 prefers ice-water immersion for life-threatening hyperthermia. Check temperature, glucose, potassium, CK, creatinine, troponin and an ECG, and give fluids for rhabdomyolysis.
- Pulmonary EmbolismSupporting the failing RV: Intubation can trigger arrest: induction drops SVR, positive pressure cuts venous return, apnea raises CO₂ and PVR. If unavoidable: norepinephrine running, expert operator, preoxygenate, reduced-dose etomidate or ketamine, VT 6 mL/kg, plateau <30, low PEEP, ECMO team aware.
- Right Heart Failure and Pulmonary HypertensionIntubation and home prostacyclin: Etomidate or reduced-dose ketamine; avoid propofol boluses; keep apnea short.
Practice Airway and RSI questions free74 exam-style questions with rationales on the topic where ketamine comes up most. No account or download needed.
Other sedation, analgesia and paralysis
- Propofol
- Dexmedetomidine
- Midazolam
- Fentanyl
- Cisatracurium
- Hydromorphone
- Rocuronium
- Vecuronium
- Pentobarbital
- Remifentanil
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.