KETAM

Composition
Each 10 ml vial contains:
Ketamine (as hydrochloride)        500 mg
Benzethonium chloride                   1 mg
Water for injection                        10 mg

Properties and Mode of Action
KETAM produces dissociative anaesthesia characterised by catalepsy, amnesia, and marked analgesic which may persist into the recovery period. There is often an increase in muscle tone and the patient's eyes may remain open for all or part on the period of anaesthesia. It may be administered by intravenous or intramuscular injection. Following IV administration, KETAM concentration has an initial slope (a-phase) lasting about 45 minutes with a half-life of 10 - 15 minutes, corresponding to the anaesthetic effect. The anaesthetic action is terminated by redistribution from the C.N.S. and by hepatic biotransformation. The b-phase half-life is 2.5 hours. KETAM crosses the placenta.

Indications
The sole anaesthetic agent for diagnostic and surgical procedures that do not require muscle relaxation. KETAM is best suited for short procedures, but it can be used with additional doses for longer procedures. For the induction of anaesthesia prior to the administration of other general anaesthetics KETAM is used to supplement low-potency agents, such as nitrous oxide.

Dosage and Administration
Dosage should be individualized.
Inducation:
I.V. route:
2 mg/kg over 60 seconds usually produces surgical anaesthesia within 30 seconds and lasting for 5 - 10 minutes.
IM route:
10 mg/kg usually produces surgical anaesthesia within 3 - 4 minutes and lasting for 12 - 25 minutes.
Maintenance:
Increments of one - half to the full induction dose may be repeated as needed for maintenance of anaesthesia.
Dilution:
To prepare a dilute solution containing 1mg/ml, transfer 10 ml (50 mg/ml vial) to 500 ml of 5% Dextrose Injection or Sodium Chloride (0.9%) Injection and mix well.
Compatibility:
Do not mix KETAM and barbiturates or diazepam in one syringe or infusion flask.

Precautions
Monitor cardiac function continuously during the procedure in patients with hypertension or cardiac decompensation. Safety for use during pregnancy has not been established. In surgery or diagnostic procedures of the pharynx, larynx or bronchial tree, do not administer KETAM alone. Muscle relaxants, with proper attention to respiration may be required. Patients should be warned not to drive or operate hazardous machinery or engage in hazardous activities for 24 hours or more after anaesthesia.

Drug Interactions
Barbiturates or narcotics may prolong the recovery time if used with KETAM. Halothane blocks the cardiovascular stimulatory effects of KETAM. Tubocurarine and non-depolarizing muscle relaxants may increase the neuromuscular effects resulting in prolonged respiratory depression. Thyroid hormones if used with KETAM may produce hypertension and tachycardia.

Contra_indications
Patients in whom a significant elevation of blood pressure would be a serious hazard, psychiatric disorders, patients with increased intraocular or C.S.F. pressure, and hypersensitivity.

Side effects
Elevated blood pressure and pulse rate, diplopia, nystagmus or slight elevation in intra-ocular pressure, enhanced skeletal muscle tone, anorexia, nausea, vomiting or hypersalivation may occur. Following rapid IV administration of high doses, severe depression of respiration or apnea occur Emergency psychological reactions may occur and the incidence may be reduced by using lower dosage with I.V. diazepam

Presentation
KETAM Vials : Vials of 10 ml each.
KETAM Ampoules : Ampoules of 2 ml each.