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Ketamine
Description: Ketamine is a nonbarbiturate, sedative hypnotic used parenterally to provide anesthesia for short diagnostic and surgical procedures. It is also used as an inducing agent, as an adjunct to supplement low-potency anesthetics such as nitrous oxide, and as a supplement to local and regional anesthesia. Ketamine can be used concomitantly with muscle relaxants without complication because it does not provide muscle relaxation of its own. It is a fairly short-acting agent that provides a profound, rapid, dissociative state and a short recovery time. Mechanism: Although the exact mechanism of action is not known, ketamine appears to be an agonist at CNS muscarinic acetylcholine-receptors and opiate-receptors. Ketamine depresses the thalamocortical pathways involved in pain perception and has been shown to suppress spinal cord activity. Clinical effects observed following ketamine administration include a "dissociative anesthesia," increased blood pressure, and minimal respiratory depression. The patient's airway remains intact due to maintenance of pharyngeal and laryngeal reflexes. Pharmacokinetics: Ketamine is administered parenterally, either IV or IM. It is rapidly absorbed following IM injection and quickly distributed into the brain and other highly perfused tissues. The alpha phase (distribution phase) lasts ~45 minutes, with a half-life of 10 - 15 minutes. It is this first phase that corresponds clinically to the anesthetic effect of the drug. When administered intravenously, a sensation of dissociation occurs in about 15 seconds, and anesthesia occurs within 30 seconds. With IM injection, anesthesia onset is 3 to 4 minutes. The anesthetic effects are terminated by a combination of redistribution and hepatic biotransformation, and metabolites are primarily excreted by the kidneys. For general anesthesia induction, the IV

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