MOA
- Ketamine primarily functions as a non-competitive NMDA receptor antagonist.
- At very low doses, ketamine provides analgesia without other neurologic effects.
- At higher doses, ketamine has anti-seizure effects and dissociative effects.
- Ketamine also binds to mu and kappa opioid receptors. (Paw and Shulman 2025)
- Ketamine is a racemic mixture. S(+) ketamine is 2-3 times more potent than R(-) ketamine.
Uses
Adverse Effects
- Anaphylaxis (1 in 4000-25000 RARE)
- Laryngospasm (esp. in Peds)
- unpredictable, always be prepared to intervene in procedural sedation
- Uncommon in adults unless the larynx is being directly manipulated (e.g., during bronchoscopy).
- Hypertension
- d/t sympathomimetic effects
- Hypersalivation, increased bronchial secretions
- This may be especially problematic with a BiPAP mask interface.
- IV glycopyrrolate may be used to control secretions, at the risk of causing further tachycardia.
- Psychomimetic effects (although usually not problematic, there is a risk of causing disturbing hallucinations).
- Nausea/vomiting during recovery.
- Ulcerative cystitis may occur due to chronic, high-dose abuse.