Ketamax Special Precautions

To be used only in hospitals by or under the supervision of experienced medically qualified anesthetists except under emergency conditions.
As with any general anesthetic agent, resuscitative equipment should be available and ready for use.
Barbiturates and Ketamine, being chemically incompatible because of precipitate formation, should not be injected from the same syringe.
Prolonged recovery time may occur if barbiturates and/or narcotics are used concurrently with Ketamine.
Emergence delirium phenomena may occur during the recovery period. The incidence of these reactions may be reduced if verbal and tactile stimulation of the patient is minimized during the recovery period. This does not preclude the monitoring of vital signs.
Because pharyngeal and laryngeal reflexes usually remain active, mechanical stimulation of the pharynx should be avoided unless muscle relaxants, with proper attention to respiration, are used.
Although aspiration of contrast medium has been reported during Ketamine anesthesia under experimental conditions in clinical practice aspiration is seldom a problem.
Cardiac function should be continually monitored during the procedure in patients found to have hypertension or cardiac decompensation.
Since an increase in cerebrospinal fluid pressure has been reported during Ketamine anesthesia, Ketamine should be used with special caution in patients with preanesthetic elevated cerebrospinal fluid pressure.
Respiratory depression may occur with overdosage of Ketamine, in which case supportive ventilation should be employed. Mechanical support of respiration is preferred to the administration of analeptics.
The intravenous dose should be administered over a period of 60 seconds. More rapid administration may result in transient respiratory depression or apnea.
In surgical procedures involving visceral pain pathways, Ketamine should be supplemented with an agent which obtunds visceral pain.
Use with caution in the chronic alcoholic and the actually alcohol-intoxicated patient.
When Ketamine is used in an outpatient basis, the patient should not be released until recovery from anesthesia is complete and then should be accompanied by a responsible adult.