Induction of general anesthesia; Procedural sedation
#仿單變更2021

General Anesthetic
Ketamine is a noncompetitive NMDA receptor antagonist that blocks glutamate. Low (subanesthetic) doses produce analgesia, and modulate central sensitization, hyperalgesia and opioid tolerance.

1. Metabolism: Hepatic; N-dealkylation, hydroxylation, conjugation, dehydration
2. Elimination: Half Life greater than 2.5 h (Alpha phase: 10 min to 15 min; Beta phase 2.5 h)

1. Hypersensitivity to ketamine or any component of the formulation
2. Conditions in which an increase in blood pressure would be hazardous

Fetal risk cannot be ruled out.

Infant risk cannot be ruled out.

1. Central nervous system: Prolonged emergence from anesthesia, drug dependence, hypertonia, increased cerebrospinal fluid pressure
2. Cardiovascular: Bradycardia, cardiac arrhythmia, hypotension, increased blood pressure, increased pulse
3. Dermatologic: Erythema, morbilliform rash, rash at injection site
4. Endocrine & metabolic: Central diabetes insipidus
5. Gastrointestinal: Anorexia, nausea, sialorrhea , vomiting
6. Genitourinary: Bladder dysfunction, cystitis, dysuria, hematuria, urinary frequency, urinary incontinence, urinary urgency
7. Hypersensitivity: Anaphylaxis
8. Local: Pain at injection site, maculopapular rash<20210220>
9. Neuromuscular & skeletal: Laryngospasm, Tonic convulsive exercise similar to epilepsy<20210220>
10. Ophthalmic: Diplopia, increased intraocular pressure, nystagmus
11. Renal: Hydronephrosis (曾有長期(1個月以上至數年)使用ketamine病人發生膀胱炎，包含出血性膀胱炎、急性腎臟受損、腎臟積水、輸尿管障礙)<20210220>
12. Respiratory: Airway obstruction, apnea, respiratory depression
13. Dependence: May cause dependence (withdrawal symptoms on discontinuation) and tolerance with prolonged use.

Administration:
Rapid IV administration (ie, over fewer than 60 seconds) may increase risk of respiratory depression or apnea and enhanced pressor response
General anesthesia; Induction of general anesthesia; Procedural sedation:
1. Induction:
(1) Initial, IV: 1-4.5 mg/kg IV as a single dose (average 2 mg/kg to produce 5 to 10 minutes of surgical anesthesia)
(2) Alternative, IV: 1-2 mg/kg IV at 0.5 mg/kg/min.
(3) Initial, IM: 6.5-13 mg/kg IM as a single dose (10 mg/kg will usually produce 12 to 25 minutes of surgical anesthesia)
2. Maintenance: increments of one-half to the full induction dose may be repeated as needed
Rapid sequence intubation, Induction:
2 mg/kg IV

General anesthesia; Induction of general anesthesia:
1. Induction:
(1) (>16 years) Initial, IV: 1-4.5 mg/kg IV as a single dose (average 2 mg/kg to produce 5 to 10 minutes of surgical anesthesia)
(2) (>16 years) Initial, IM: 6.5-13 mg/kg IM as a single dose (10 mg/kg will usually produce 12 to 25 minutes of surgical anesthesia)
2. Maintenance:
(>16 years) Increments of one-half to the full induction dose may be repeated as needed
Procedural sedation:
1. Induction:
(1) Initial, IV: (>16 years) 1-4.5 mg/kg IV as a single dose; (3 days to 10 years) 2 mg/kg IV off-label
(2) Initial, IM: (>16 years) 6.5-13 mg/kg IM as a single dose; (<12 years) 2 to 2.5 mg/kg; (12-15 years) 4 mg/kg
2. Maintenance:
(>16 years) Increments of one-half to the full induction dose may be repeated as needed

There are no dosage adjustments provided in the manufacturer's labeling.

There are no dosage adjustments provided in the manufacturer's labeling.