Managing Complications in Pregnancy and Childbirth: - IAWG

KETAMINE P-13TABLE P-5Indications and precautions for ketamine anaesthesiaIndications• Any procedure that is relativelyshort (less than 60 minutes) andwhere muscle relaxation is notrequired (e.g. repair of perineal tearsor extensive cervical tears, manualremoval of placenta, caesareansection, drainage of breast abscess)• Suitable as a back-up if inhalationapparatus (or gas supply for aBoyle’s anaesthesia machine) failsor for general anaesthesia is usedwithout inhalation apparatusPrecautions• When used alone, ketamine cancause unpleasant hallucinations.Avoid use in women with a historyof psychosis. To preventhallucinations, give diazepam 10 mgIV after the baby is delivered• By itself ketamine does not providemuscular relaxation, so the incisionfor caesarean section may need to belonger• Ketamine should not be used inwomen with elevated bloodpressure, pre-eclampsia, eclampsiaor heart disease• Review general care principles (page C-17) and start an IV infusion(page C-21).• Ketamine may be given IM, IV or by infusion. The dose ofketamine is variable.- Most women will require 6–10 mg/kg body weight IM. Surgicalanaesthesia is reached within 10 minutes and lasts up to 30minutes;- Alternatively, give 2 mg/kg body weight IV slowly over 2minutes (in which case the action lasts for only 15 minutes);- Infusion of ketamine is described below. This is suitable forcaesarean section;- When additional pain relief is needed, give ketamine 1 mg/kgbody weight IV.Ketamine anaesthesia should not be used in women with elevatedblood pressure, pre-eclampsia, eclampsia or heart disease.