Ketamine:

Intravenous, N-methyl-D-aspartate (NMDA) receptor antagonist

ECMO Dose Adjustment:

NONE

Renal Impairment Dose Adjustment:

NONE

CRRT Dose Adjustment:

NONE

Hepatic Impairment Dose Adjustment:

NONE

Adult Starting Dose^:

Adult Bolus: 0.2-0.5 mg/kg IV, then continuous infusion 0.2-0.3 mg/kg/hr

Pediatric Starting Dose^:

Pediatric Bolus: 0.3-0.5 mg/kg IV, then continuous infusion: 0.3-0.5 mg/kg/hr

Neonatal Starting Dose^:

Neonatal Bolus: 0.3-0.5 mg/kg IV, then continuous infusion: 0.3-0.5 mg/kg/hr

^Always use the lowest effect dose to an objective endpoint (e.g., sedation scale).

Intravenous sedative physicochemical and pharmacokinetic characteristics

Drug	Ketamine


Onset (min)	1-2
Log P	2.9
Protein Binding (%)	10-30
Metabolism / Elimination	Hepatic
Dose Adjustment on ECMO	-
Dose Range*	Adult: 0.2-2.5 mg/kg/hr (1-8 mcg/kg/min)
	Pediatric: 0.3-2.5 mg/kg/hr
	Neonatal: 0.3-2.5 mg/kg/hr

- Minimal sequestration; no need for Dose Adjustment

++ Moderate sequestration; may require Dose Adjustment

+++ Significant sequestration; need for Dose Adjustment

*Titrate to patient-specific goals, using the lowest effective dose. Dose ranges represent doses typically used in clinical practice; in some situations, patients may require doses above the usual dose range to achieve patient-specific goals.