Ketamine

What it is used for

• Anesthesia
• Anesthesia
• Anesthesia
• Camelids (llamas and alpacas) - Anesthetic
• Camelids - Procedural pain (e.g., castrations) when recumbency is desired
• Restraint
• Diagnostic or minor surgical procedures not requiring skeletal muscle relaxation
• Immobilizing agent (requiring more sedation)
• Highly aggressive cats
• NMDA antagonist for adjunctive pain control (mild to moderate pain)
• Intraoperative use (if anesthesia induced with drug other than ketamine)
• In combination with opioids or lidocaine
• MLK (morphine/lidocaine/ketamine) mixture
• Injectable anesthesia
• Anesthesia
• Anesthesia
• CRI for adjunctive analgesia
• Field anesthesia
• Induction
• Foals and ponies induction/maintenance
• Induction of surgical colic patients
• Intra-operatively to reduce movement with light general anesthesia
• Anesthesia (<100 grams: canaries, finches, budgies)
• Anesthesia (250-500 grams: parrots, pigeons)
• Anesthesia (500 grams-3 kg: chickens, owls, hawks)
• Anesthesia (>3 kg: ducks, geese, swans)
• In combination with xylazine
• In combination with diazepam
• In combination with acepromazine
• Anesthesia
• Anesthesia
• Anesthesia
• Mice: Chemical restraint (Alone)
• Mice: Chemical restraint (with diazepam)
• Mice: Chemical restraint (with xylazine)
• Rats: Chemical restraint (Alone)
• Rats: Chemical restraint (with diazepam)
• Rats: Chemical restraint (with xylazine)
• Hamsters/Gerbils: Chemical restraint (Alone)
• Hamsters/Gerbils: Chemical restraint (with diazepam)
• Guinea pig: Chemical restraint (Alone)
• Guinea pig: Chemical restraint (with diazepam)
• Guinea pig: Chemical restraint (with xylazine)
• Rabbits: Chemical restraint (Alone)
• Rabbits: Chemical restraint (with diazepam)
• Rabbits: Chemical restraint (with xylazine)
• Rabbits: Chemical restraint (Alone)
• Rabbits: Induction (with diazepam)
• Rabbits: Anesthesia without inhalants (with diazepam)
• Rodents: Injectable anesthesia
• Rabbits: Injectable anesthesia
• Adjunct to anesthesia (geriatric/renal/liver dysfunction as premed prior to propofol/mask)
• Slightly heavier sedation for radiographic procedures
• Minor surgery, Penn hip or OFA-types of radiographic procedures requiring muscle relaxation
• Surgical plane of anesthesia for OHE, castration, or abdominal surgery
• Immobilizing extremely fractious dogs and wolf-hybrid dogs
• NMDA antagonist for adjunctive pain control (mild to moderate pain)
• Intraoperative use (if anesthesia induced with drug other than ketamine)
• In combination with opioids or lidocaine
• Medium to small land Tortoises
• Freshwater Turtles
• Giant Land Tortoises (200 kg Aldabra tortoise)
• Smaller Aldabra tortoises
• Iguanas

How it is given

Possible side effects

• Hypertension
• Hypersalivation
• Respiratory depression (at high doses or rapid IV administration)
• Hyperthermia (especially in cats)
• Emesis
• Vocalization
• Erratic and prolonged recovery (emergence delirium)
• Dyspnea
• Spastic jerking movements and muscular tremors
• Seizures (up to 20% of cats at therapeutic doses)
• Hypertonicity and opisthotonos
• Cardiac arrest
• Pain after IM injection
• Eyes remain open (risk of corneal drying/ulceration)
• Cardiovascular depression and arrhythmias (in animals with high sympathetic tone, shock, or severe CV disease)
• Tachycardia (following high IV doses)
• Marked respiratory depression (in some animals)
• Skeletal muscle hypertonicity and spontaneous movement (if used alone)
• Spacey, abnormal behaviour or dysphoria during recovery (1-2 hours)
• Drug accumulation and prolonged recovery (with prolonged infusion)

Cautions & contraindications

• Prior hypersensitivity reactions to ketamine
• Animals intended for human consumption
• Use as a sole agent for major surgery (due to poor muscle relaxation and visceral analgesia)
• Increased cerebrospinal fluid (CSF) pressure or head trauma
• Significant hypertension, heart failure, or arterial aneurysms
• Hypertrophic cardiomyopathy (HCM) in cats
• Increased intra-ocular pressure or open globe injuries (relative)
• Procedures involving the pharynx, larynx, or trachea (relative)
• Preexisting seizure disorders (use with extreme caution)
• Animals whose eyes are at risk of perforation
• Raised intraocular pressure (IOP)
• Raised intracranial pressure (ICP)
• > **Cardiovascular Caution**: Ketamine increases heart rate, blood pressure, and myocardial oxygen consumption. Avoid in patients where this is detrimental (e.g., unstable shock, congestive heart failure, hypertrophic cardiomyopathy). > **Ocular Care**: Cats' eyes remain open after receiving ketamine. Protect from injury and apply an ophthalmic lubricant (e.g., Lacri-Lube) to prevent excessive corneal drying. * **Hepatic/Renal Insufficiency**: Use with caution. In cats, ketamine is excreted almost exclusively via the kidneys; reduce doses or use cautiously in feline renal disease. * **Sympathetic Tone**: Use with caution in animals with preexisting increased sympathetic tone (e.g., pheochromocytoma, hyperthyroidism). * **Recovery**: Minimize exposure to handling or loud noises during the recovery period to reduce the incidence of emergence reactions (delirium, thrashing), but continue to monitor vital signs closely. * **Hemorrhage**: Because ketamine can increase blood pressure, careful control of post-surgical hemorrhage (e.g., declawing) is required.

Drug interactions

• Chloramphenicol (parenteral): May prolong the anesthetic actions of ketamine
• CNS Depressants (Narcotics, barbiturates, diazepam): May prolong the recovery time after ketamine anesthesia
• Halothane: Recovery rates may be prolonged and the cardiac stimulatory effects of ketamine may be inhibited; close monitoring of cardiac status is recommended
• Ivermectin: Recommended not to use ivermectin in reptiles within 10 days of ketamine
• Neuromuscular blockers (e.g., succinylcholine, tubocurarine): May cause enhanced or prolonged respiratory depression
• Thyroid hormones: May induce severe hypertension and tachycardia; beta-blockers may be of benefit in treating these effects
• Alpha-2 adrenergic agonists (e.g., medetomidine, dexmedetomidine): Synergistic anaesthesia and prevention of muscle hypertonicity. Reversal of the alpha-2 agonist must be delayed until 45 minutes after ketamine administration to prevent unopposed ketamine excitation.
• Benzodiazepines: Synergistic anaesthesia and prevention of ketamine-induced skeletal muscle hypertonicity.

Frequently asked questions