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Ketamine is a prescription medicine used as a sedative for diagnostic and surgical procedures. It induces a trance-like state while providing pain relief, sedation, and memory loss. Other uses include sedation in intensive care and treatment of pain and depression. It may be used alone or with other medications.
Ketamine hydrochloride injection is indicated as the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. It is best suited for short procedures but it can be used, with additional doses, for longer procedures.
Ketamine hydrochloride injection is indicated for the induction of anesthesia prior to the administration of other general anesthetic agents.
Uses of Ketamine
Uses as an anesthetic:
- Anesthesia in children, as the sole anesthetic for minor procedures or as an induction agent followed by neuromuscular blocker and tracheal intubation
- Asthmatics or people with chronic obstructive airway disease
- As a sedative for physically painful procedures in emergency departments
- Emergency surgery in field conditions in war zones
- To prevent opioid-induced hyperalgesia
- Ketamine is frequently used in severely injured people and appears to be safe in this group.
- It is the drug of choice for people in traumatic shock who are at risk of hypotension.
- Low blood pressure is harmful in people with severe head injury and ketamine is least likely to cause low blood pressure, often even able to prevent it.
- The effect of ketamine on the respiratory and circulatory systems is different from that of other anesthetics. When used at anesthetic doses, it will usually stimulate rather than depress the circulatory system. It is sometimes possible to administer ketamine anesthesia without protective measures to the airways. Ketamine is considered relatively safe because protective airway reflexes are preserved.
- It has been successfully used to prevent postanesthetic shivering.
Ketamine is used as a bronchodilator in the treatment of severe asthma.
Ketamine is sometimes used in the treatment of status epilepticus that has failed to adequately respond to standard treatments.
- Ketamine may be used for postoperative pain management. Low doses of ketamine may reduce morphine use, nausea, and vomiting after surgery. It is especially useful in the prehospital setting, due to its effectiveness and low risk of respiratory depression.
- Ketamine has similar efficacy to opioids in a hospital emergency department setting for management of acute pain and for control of procedural pain.
- It may also be used as an intravenous analgesic with opiates to manage otherwise intractable pain, particularly if this pain is neuropathic. It has the added benefit of counteracting spinal sensitization or wind-up phenomena experienced with chronic pain.
- Ketamine has been found to be a rapid-acting antidepressant in depression.
- It also may be effective in decreasing suicidal ideation.
A single low, sub-anesthetic dose of ketamine given via intravenous infusion may produce antidepressant effects within four hours in people with depression. These antidepressant effects may persist for up to several weeks following a single infusion.
Dosage and Administration
As with other general anesthetic agents, the individual response to ketamine hydrochloride is somewhat varied depending on the dose, route of administration, and age of patient, so that dosage recommendation cannot be absolutely fixed. The drug should be titrated against the patient’s requirements.
If the ketamine hydrochloride dose is augmented with diazepam, the two drugs must be given separately. Do not mix ketamine hydrochloride and diazepam in syringe or infusion flask.
Side Effects of Use
Common side effects include agitation, confusion, or hallucinations as the medication wears off. Elevated blood pressure and muscle tremors are relatively common. Spasms of the larynx may rarely occur.