Ketaminum

Ketamine – drug for not inhalation general anesthesia.

Form of release and structure

Dosage form – solution for intramuscular (in oil) and intravenous (in/in) introductions: the colourless or poorly painted transparent liquid (on 2 ml and 5 ml in ampoules or on 5 ml in bottles, on 5 pieces in a blister strip packaging, in a cardboard pack 1 or 2 packagings).

Active ingredient – Ketaminum a hydrochloride, in 1 ml of solution of 57,6 mg that is equivalent to 50 mg of Ketaminum.

Auxiliary components: sodium chloride, a benzetoniya chloride, water for injections.

Indications to use

• Basic and introduction general anesthesia (especially in need of preservation at patients of independent breath or at patients with low arterial pressure, and also at operations with artificial ventilation of the lungs by the respiratory mixes which are not including a dinitrogene oxide (nitrous oxide));
• Anesthesia at the emergency surgical interventions, including situations at evacuation of patients with blood loss and traumatic shock;
• As a part of multicomponent intravenous anesthesia at various surgical interventions;
• Anesthesia at catheterization of heart, endoscopy and other diagnostic procedures;
• Insignificant surgical manipulations when bandaging burn and other defeats.

Contraindications

• Myocardial infarction (including the period of the last 6 months);
• Arterial hypertension and other pathologies for which increase in arterial pressure is contraindicated;
• Stenocardia;
• Heavy renal failure;
• Disturbance of cerebral circulation (including in the anamnesis);
• The epilepsy and other diseases proceeding with convulsive activity;
• Alcoholism;
• Preeclampsia and eclampsia;
• Period of pregnancy and breastfeeding;
• Hypersensitivity to drug components.

With care apply a ketamine anesthesia at dekompensirovanny chronic heart failure, carrying out operation on a drink or a throat.

Route of administration and dosage

Ketaminum is applied in the way in/in fractional, single-step jet, drop or introductions in oil.

For adults the dose of drug is appointed from calculation: on 2-3 mg at in/in or on 4-8 mg on 1 kg of weight of the patient at introduction in oil.

The recommended dosing for maintenance of anesthesia at in introduction makes 0,5-1 mg or at in oil – on 3 mg on 1 kg of weight. Into drug it can be entered kapelno by means of an infuzomat with a speed of 2 mg at 1 kg of 1 hour or systems for infusions with introduction of 0,1% of solution of Ketaminum prepared from 5% by solution of a dextrose (glucose) or 0,9% chloride sodium solution, the speed of infusion of 20-50 drops in a minute.

At children introduction anesthesia at a balanced anesthesia is carried out after the corresponding premedication by single introduction of a dose in oil of drug at the rate of 4-5 mg on 1 kg of weight of the child in the form of 5% of solution.

At the main anesthesia Ketaminum enter solution, in oil in the form of 5%, or in/in in a dose from calculation for 2-3 mg on 1 kg of weight – in one step struyno (1% solution) or kapelno (0,1% solution) with a speed of 50-60 thaws a minute.

Dosing for introduction in oil depends on age and the child's weight:

• To babies till 1 year – from calculation for 8-12 mg on 1 kg;
• Children are 1-6 years old – on 6-10 mg on 1 kg;
• Teenagers are 7-14 years old – on 4-8 mg on 1 kg.

The general anesthesia is supported by repeated injections of drug in a dose: in oil – from calculation for 3-5 mg on 1 kg or in/in (struyno or kapelno) – on 0,5-1 mg on 1 kg, the speed of infusion is 0,1% of solution of drug of 30-60 drops a minute.

Effect of Ketamine is increased a combination to antipsychotic means (Droperidolum) and fentanyl, Promedolum and other analgetics, at this combination the dose of drug is recommended to be reduced.

Side effects

Use of Ketaminum can cause side effects:

• From cardiovascular system: tachycardia, increase in arterial pressure;
• From a nervous system: oppression of respiratory system, muscular rigidity, involuntary reduction of muscles; in the period of an exit from the general anesthesia – a hallucination, psychomotor excitement, psychosis, a long disorientation;
• From the alimentary system: nausea, hypersalivation;
• From respiratory system: an asthma, obturation of upper respiratory tracts because of sticking of language and a spasm of chewing muscles, a sialosis and high bronchial secretion;
• Local reactions: a pain syndrome in an injection site and a hyperemia on the vein course.

Special instructions

Use of Ketaminum is shown only in the conditions of ambulance or a hospital.

When using drug the patient can have a retraction of language or a spasm of chewing muscles therefore it is necessary to control breath function, especially passability of upper respiratory tracts.

When carrying out premedication it is recommended to include in composition of medicines: atropine or a metotsiniya iodide – for the prevention of increase in secretion of sialadens and mucous membranes; diazepam (in oil or in/in) – for prevention of uncontrollable twitchings and muscular rigidity; diazepam or Droperidolum – for the purpose of the prevention of development of psikhomimetichesky effects.

Slow introduction of the main dose of drug which should not exceed 3 mg on 1 kg of weight of the patient, and performing inhalation with air mix with oxygen in the ratio 2:1 is recommended.

When carrying out surgical interventions on a throat and a throat using Ketaminum, it is recommended to be careful and apply muscle relaxants.

Medicinal interaction

Drug strengthens action of narcotic analgetics, neuroleptics, drugs for the general anesthesia, anxiolytics (tranquilizers) and other means oppressing the central nervous system.

The combination to anxiolytics, antipsychotic means weakens a cardiopromoting effect of Ketaminum.

Use of Ketaminum is possible only in 1-2 days after cancellation of drugs of lithium, lincomycin, in 15 days after the termination of reception of inhibitors of a monoaminooxidase.

Solution of drug cannot be mixed with barbiturates in one syringe.

Ketaminum does not exert impact on effect of succinylcholine and a pankuroniya, strengthens myorelaxation action of Dithylinum and tubocurarine.

Simultaneous use of Droperidolum, Sibazonum and other benzodiazepines reduces risk of development of arterial hypertension, tachycardia, emergence of motor and psikhomimetichesky activity.

As simultaneous use of Ketaminum with the drugs possessing the stimulating impact on cardiovascular system and sympathomimetics leads to strengthening of aritmogenny and hypertensive action, increase in need of a myocardium for oxygen, it is recommended to avoid these combinations.

The patients accepting hormones of a thyroid gland and iodinated drugs in the period of the general anesthesia are subject to bigger risk of tachycardia and increase in arterial pressure.

Terms and storage conditions

To store in the place protected from light. To protect from children.

Period of validity – 2 years.