Managing Complications in Pregnancy and Childbirth: - IAWG

P-14 KetamineKETAMINE INFUSIONPREMEDICATION• Give atropine sulfate 0.6 mg IM 30 minutes prior to surgery.• Give diazepam 10 mg IV at the time of induction to preventhallucinations (for caesarean section, give diazepam after the babyis delivered).• Give oxygen at 6–8 L per minute by mask or nasal cannulae.INDUCTION AND MAINTENANCE• Check the woman’s vital signs (pulse, blood pressure, respiration,temperature).• Insert a mouth gag to prevent airway obstruction by the tongue.• Induction of anaesthesia is achieved by slowly administeringketamine 2 mg/kg body weight IV slowly over 2 minutes. For shortprocedures lasting less than 15 minutes, this will provide adequateanaesthesia.• For longer procedures, infuse ketamine 200 mg in 1 L dextrose at 2mg per minute (i.e. 20 drops per minute).• Check the level of anaesthesia before proceeding with the surgery.Pinch the incision site with forceps. If the woman feels the pinch,wait 2 minutes and then retest.• Monitor vital signs (pulse, blood pressure, respiration,temperature) every 10 minutes during the procedure.POST-PROCEDURE CARE• Discontinue ketamine infusion and administer a postoperativeanalgesic suited to the type of surgery performed (page C-37).• Maintain observations every 30 minutes until the woman is fullyawake; ketamine anaesthesia may take up to 60 minutes to wear off.