Ketamax Dosage/Direction for Use

Adults, elderly (over 65 years) and children: For surgery in elderly patients Ketamine has been shown to be suitable either alone or supplemented with other anesthetic agents.
Preoperative preparations: Ketamine had been safely used alone when the stomach was not empty. However, since the need for supplemental agents and muscle relaxants cannot be predicted, when preparing for elective surgery, it is advisable that nothing be given by the mouth for at least six hours prior to anesthesia.
Atropine, Scopolamine, or other drying agent should be given at an appropriate interval prior to induction.
Midazolam, Diazepam, Lorazepam, or Flunitrazepam used as a premedicant or as an adjunct to Ketamine, have been effective in reducing the incidence or emergence reactions.
Onset and duration: As with other general anesthetic agents, the individual response to Ketamine Injection is somewhat varied depending on the dose, route of administration, age of patient, and concomitant use of other agents, so that dosage recommendation cannot be absolutely fixed. The dose should be titrated against the patient's requirements.
Because of rapid induction following intravenous injection, the patient should be in a supported position during administration. An intravenous dose of 2 mg/kg of body weight usually produces surgical anesthesia within 30 seconds after injection and the anesthetic effect usually lasts 5 to 10 minutes. An intramuscular dose of 10 mg/kg body weight usually produces surgical anesthesia within 3 to 4 minutes following injection and the anesthetic effect usually lasts 12 to 25 minutes. Return to consciousness is gradual.
Ketamine Injection as the sole anesthetic agent: Intravenous Infusion: The use of Ketamine Injection by continuous infusion enables the dose to be titrated more closely, thereby reducing the amount of drug administered compared with intermittent administration. This results in a shorter recovery time and better stability of vital signs.
A solution containing 1 mg/mL of Ketamine, in dextrose 5% or sodium chloride 0.9% is suitable for administration by infusion.
Induction: An infusion corresponding to 0.5-2.0 mg Ketamine/kg as total induction dose.
Maintenance of anesthesia: Anesthesia may be maintained using a microdrip infusion of 10-45 micrograms/kg/min (1-3 mg/min). The rate of infusion will depend on the patient's reaction and response to anesthesia. The dosage required may be reduced when a long acting neuromuscular blocking agent is used.
Intermittent Injection: Induction: Intravenous route: The initial dose of Ketamine Injection administered intravenously may range from 1 mg/kg to 4.5 mg/kg (in terms of Ketamine base).
The average amount required to produce 5 to 10 minutes of surgical anesthesia has been 2 mg/kg. It is recommended that intravenous administration be accomplished slowly (over a period of 60 seconds). More rapid administration may result in respiratory depression.
Intramuscular route: The initial dose of Ketamine hydrochloride Injection administered intramuscularly may range from 6.5 to 13 mg/kg (in terms of Ketamine base).
A low initial intramuscular dose of 4 mg/kg has been used in diagnostic maneuvers and produces not involving intensely painful stimuli. A dose of 10 mg/kg will usually produce 12 to 25 minutes of surgical anesthesia.
Maintenance of anesthesia: Lightening of anesthesia may be indicated by nystagmus, movements in response to stimulation, and vocalization.
Anesthesia is maintained by the administration of additional doses of Ketamine by either the intravenous or intramuscular route.
Each additional dose from 1/2 of the full induction dose recommended above for the route selected for maintenance, regardless of the route used for induction.
The larger the total amount of Ketamine administered, the longer will be the time to complete recovery.
Purposeless and tonic-clonic movements of extremities may occur during the course of anesthesia. These movements do not imply a light plane and are not indicative of the need for additional doses of the anesthetic.
Ketamine as induction agent prior to the use of other general anesthetics: Induction is accomplished by a full intravenous or intramuscular dose of Ketamine Injection as defined previously. If Ketamine has been administered intravenously and the principal anesthetic is slow-acting, a second dose of Ketamine may be required 5 to 8 minutes following the initial dose, If Ketamine has been administered intramuscularly and the principal anesthetic is rapid-acting, administration of the principal anesthetic may be delayed up to 15 minutes following the injection of Ketamine.
Ketamine Injection as supplement to anesthetic agents: Ketamine is clinically compatible with the commonly used general and local anesthetic agents when an adequate respiratory exchange is maintained. The dose of Ketamine for use in conjunction with other anesthetic agents is usually in the same range as the dosage stated previously; however, the use of another anesthetic agent may allow a reduction in the dose of Ketamine.
Management of patients in recovery: Following the procedure the patient should be observed but left undisturbed. This does not preclude the monitoring of vital signs. If, during the recovery, the patient shows any indication of emergence delirium, consideration may be given to the use of one of the following agents: Diazepam (5 to 10 mg i.v. in adult). A hypnotic dose of a thiobarbiturate (50 to 100 mg i.v.) may be used to terminate severe emergence reactions. If any one of these agents is employed, the patient may experience a longer recovery period.