Ketamine

NMDA Antagonist·Psychiatry - Acute Calming & Sedation

Procedural sedation, refractory severe pain, induction of anaesthesia

S8NMDAKetalarTGA

Max Dose

Titrated

Half-life

2-3 h

Airway

PRESERVED

Emergence

DELIRIUM RISK

Rapid Summary

Overview

Dissociative anaesthetic and powerful analgesic. Unique because it preserves respiratory drive and airway reflexes, while simultaneously boosting blood pressure and heart rate.

Maximum Dose

Titrated strictly to clinical effect (Analgesia vs Sedation vs Anaesthesia).

Clinical Focus

The ultimate 'safe' sedative for the shocked, hypotensive, or actively asthmatic patient in the ED/ICU.

Bottom Line

Ketamine is a unique dissociative anaesthetic and analgesic with emerging use in treatment-resistant depression, but causes emergence phenomena (hallucinations) and raises intracranial pressure.

Formulation & Access

Brand Names

Ketalar

Parenteral

Vials (200 mg/2 mL) for IV, IM, or SC use. Can also be given intranasally via atomiser.

Prescribing & PBS

Highly Restricted (S8). Hospital supply only.

Indications & Use

Primary

TGA

Procedural sedation, refractory severe pain, induction of anaesthesia.

Off-Label

OFF

Treatment-resistant depression (sub-anesthetic infusions), extreme acute behavioral disturbance.

Clinical Place

The go-to drug for painfully relocating joints in ED, or safely sedating a hypotensive trauma patient.

Quick reference

Class & Role

NMDA Antagonist — Dissociative anaesthetic and powerful analgesic.

Route / Formulation

Vials (200 mg/2 mL) for IV, IM, or SC use. Can also be given intranasally via atomiser. (Ketalar)

Usual Dose & Max

IV 0.1 - 0.3 mg/kg bolus. OR SC / IM 0.5 mg/kg. Titrated strictly to clinical effect (Analgesia vs Sedation vs Anaesthesia).

Key Indication Doses

Acute Severe Analgesia: IV 0.1 - 0.3 mg/kg bolus. OR SC / IM 0.5 mg/kg. Procedural Sedation: IV 0.5 - 1 mg/kg. (Often combined with low-dose midazolam to prevent emergence delirium). Severe Agitation / Excited Delirium: IM 4 - 5 mg/kg STAT (Produces rapid, deep dissociation in violently agitated patients).

Best Uses

Ketamine is a unique dissociative anaesthetic and analgesic with emerging use in treatment-resistant depression, but causes emergence phenomena (hallucinations) and raises intracranial pressure.

Avoid / Cautions

Severe uncontrolled hypertension, recent MI, aneurysms, conditions where a sudden spike in BP is fatal.

Key Risks

Neurological: Emergence phenomenon (terrifying hallucinations, vivid dreams, severe agitation as the drug wears off). Cardiovascular: Tachycardia, hypertension (Usually a desired effect in trauma, but dangerous in severe ischemic heart disease). Gastrointestinal: Hypersalivation (drooling/secretions), vomiting.

Key Interactions

Additive sedation with Benzos/Opioids, but Benzos are actually *beneficial* to prevent emergence delirium.

Monitoring

Keep the patient in a quiet, dark environment while recovering to minimize sensory overload and emergence delirium. Have suction ready for hypersalivation. Continuous ECG, BP, and SpO2 monitoring during use.

Clinical Pearl

Because Ketamine releases massive amounts of catecholamines, it acts as a potent bronchodilator. It is the absolute induction agent of choice for intubating a patient in status asthmaticus.

Access

Ketalar

Brand: Ketalar

Ketamine

NMDA Antagonist·Psychiatry - Acute Calming & Sedation

Procedural sedation, refractory severe pain, induction of anaesthesia

S8NMDAKetalarTGA

Max Dose

Titrated

Half-life

2-3 h

Airway

PRESERVED

Emergence

DELIRIUM RISK

Rapid Summary

Overview

Dissociative anaesthetic and powerful analgesic. Unique because it preserves respiratory drive and airway reflexes, while simultaneously boosting blood pressure and heart rate.

Maximum Dose

Titrated strictly to clinical effect (Analgesia vs Sedation vs Anaesthesia).

Clinical Focus

The ultimate 'safe' sedative for the shocked, hypotensive, or actively asthmatic patient in the ED/ICU.

Bottom Line

Ketamine is a unique dissociative anaesthetic and analgesic with emerging use in treatment-resistant depression, but causes emergence phenomena (hallucinations) and raises intracranial pressure.

Formulation & Access

Brand Names

Ketalar

Parenteral

Vials (200 mg/2 mL) for IV, IM, or SC use. Can also be given intranasally via atomiser.

Prescribing & PBS

Highly Restricted (S8). Hospital supply only.

Indications & Use

Primary

TGA

Procedural sedation, refractory severe pain, induction of anaesthesia.

Off-Label

OFF

Treatment-resistant depression (sub-anesthetic infusions), extreme acute behavioral disturbance.

Clinical Place

The go-to drug for painfully relocating joints in ED, or safely sedating a hypotensive trauma patient.

Quick reference

Class & Role

NMDA Antagonist — Dissociative anaesthetic and powerful analgesic.

Route / Formulation

Vials (200 mg/2 mL) for IV, IM, or SC use. Can also be given intranasally via atomiser. (Ketalar)

Usual Dose & Max

IV 0.1 - 0.3 mg/kg bolus. OR SC / IM 0.5 mg/kg. Titrated strictly to clinical effect (Analgesia vs Sedation vs Anaesthesia).

Key Indication Doses

Best Uses

Ketamine is a unique dissociative anaesthetic and analgesic with emerging use in treatment-resistant depression, but causes emergence phenomena (hallucinations) and raises intracranial pressure.

Avoid / Cautions

Severe uncontrolled hypertension, recent MI, aneurysms, conditions where a sudden spike in BP is fatal.

Key Risks

Key Interactions

Additive sedation with Benzos/Opioids, but Benzos are actually *beneficial* to prevent emergence delirium.

Monitoring

Clinical Pearl

Because Ketamine releases massive amounts of catecholamines, it acts as a potent bronchodilator. It is the absolute induction agent of choice for intubating a patient in status asthmaticus.

Access

Ketalar

Brand: Ketalar