Ketamine Dosing for Intubation

Standard Dosing Recommendations

• For rapid sequence intubation (RSI) in critically ill adults, the recommended dose is 1-2 mg/kg IV, as suggested by the American Society of Anesthesiologists 1, 2

Special Patient Populations

• In hemodynamically unstable patients, consider using the lower end of the dosing range (1 mg/kg) to minimize the risk of hypotension, according to the American College of Critical Care Medicine 3, 4

Administration Technique

• Administer ketamine as part of a rapid sequence induction protocol with neuromuscular blockade, as recommended by the American Society of Anesthesiologists 1, 3
• Have vasoconstrictors immediately available to treat any hypotension, as suggested by the American College of Critical Care Medicine 3

Monitoring and Safety Considerations

• Continuously monitor vital signs in patients receiving ketamine, including heart rate, blood pressure, and oxygen saturation, as recommended by the American Heart Association 2, 5
• Ketamine causes a dose-dependent increase in heart rate, blood pressure, and cardiac output through stimulation of the sympathetic nervous system, according to the American Society of Anesthesiologists 2

Potential Adverse Effects

• Post-intubation hypotension has been reported in 18.3% of emergency department patients receiving ketamine for RSI, as found by the American College of Emergency Physicians 4
• Laryngospasm is a rare but potential complication (0.9-1.4%), according to the American Academy of Emergency Medicine 6

Alternative Approaches

• For medication-assisted preoxygenation in agitated patients prior to RSI, ketamine can be administered at 1 mg/kg with additional 0.5 mg/kg doses until a dissociative state is achieved, as suggested by the American College of Critical Care Medicine 7