**6.4.30 Ketamine**

General anesthetic, sedative, hypnotic, analgesic and amnestic. IV, IM. It protects cardiovascular functions. It improves lung compliance, has bronchodilator effect. As ketamine favorably alters the heart and respiratory functions it can be used as a sedative agent in patients who receive mechanical ventilation and have myocardial depression induced by benzodiazepines and opiates. It can be used in cases where spontaneous ventilation is requested while sedation is provided (Biçer, 2008).

*Neonatal Dose:* 


*Sedation:* 0.5-2 mg/kg/dose IV, can be repeatedly administered at doses of 0.5 mg/kg/dose at 2-5 min. intervals or with 1-2 mg/kg/hour infusion until adequate sedation is achieved (Max. 5 mg/kg). 4-5 mg/kg/dose IM (if adequate sedation is not achieved within 10 minutes), one more dose of 2 mg/kg/dose can be administered. Rapid sequential intubation: 0.5-2 mg/kg/dose IV or 3-7 mg/kg/dose IM (1 dose). Caution: It acts fast; but slow. Aspiration and laryngospasm can be observed in patients who ventilate spontaneously in the unprotected airway. Atropine and glycopyrronium bromide are advised to use before ketamine as it increases saliva and bronchial secretions. It should not be administered in cases of increase in intracranial pressure, suspected head trauma and in convulsions whose etiology is unknown and where intracranial pressure may have increased. It can cause such reactions as hallucination and delirium and these phenomena increase by age and dose. The administration of benzodiazepines 5 minutes before ketamine is active against these phenomena (Biçer, 2008).

Side Effects: Laryngospasm, out-of-anesthesia reaction, tachycardia, hypertension, increase in intracranial pressure (Biçer, 2008).
