Ketamine injection

Ketamine injection is a general anesthetic indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation, for the induction of anesthesia before the administration of other anesthetic agents, and as a supplement to other anesthetic agents.1 It is also used for acute agitation and treatment of acute or chronic pain. Ketamine is unique sedative-hypnotic that produces dissociative anesthesia characterized by potent sedation, amnesia, and analgesia while maintaining cardiovascular stability and preserving spontaneous respiration and protective airway reflexes.12 It is similar in structure, mechanism of action, and activity to phencyclidine (PCP), but ketamine is much less potent and has a shorter duration of action.8 Ketamine has bronchodilatory properties and, in comparison to other sedatives (e.g., opioids, benzodiazepines),

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offers the advantage of fewer adverse reactions. Hence, ketamine may be an effective alternative to conventional intensive care sedation in certain clinical scenarios (e.g., patients who develop adverse cardiovascular effects with opioids or benzodiazepines, sedation with preservation of spontaneous ventilation, patients with refractory bronchospasm or status asthmaticus).91011 Ketamine is a sympathomimetic; elevations in heart rate and blood pressure are often mild-to-moderate, but it should not be used in patients in whom significant elevations would be deleterious.121 Ketamine anesthesia is notorious for producing a cataleptic state where the eyes remain open with nystagmus; this “disconnected” state may be disconcerting to caregivers and warrants proper caregiver preparation. Other prominent effects of ketamine include excessive airway secretion and emergence reactions. The latter can be managed with short-acting benzodiazepines