케타민
Ketamine
Ketamine Hydrochloride
다른 이름: Ketaset · Ketaflo · Ketalar · Ketaject · VetaKet · Anaestamine · Anesketin · Ketavet · Narketan-10 · Vetalar-V · CI-581 · CL-369 · CN-52372-2 · ketamini hydrochloridum · Ketamine hydrochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
구조화 용량 계산 근거Ketamine/benzodiazepine combinations — Postoperative analgesia
인증된 수의사 확인 필요
NA
반드시 함께 고려할 임상 맥락 (4)
- 1. Ketamine is used in many different combinations with other agents. The following are representative, but not necessarily inclusive; it is suggested to refer to a recent veterinary anesthesia reference for more information. 31,32
- 2. Do not confuse IV CRI dosages listed as mg/kg/HOUR with those listed as µg/kg/MINUTE.
- a) Ketamine/benzodiazepine combinations:
- Ketamine injection should be stored between 15°C to 30°C (59°F-86°F) and protected from light. The discard dates after first vial puncture vary by manufacturer; refer to the specific product label for further information.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
케타민(Ketamine)은 수의학에서 널리 사용되는 속효성 해리성 전신 마취제 및 진통제입니다.
- 약물 계열: 펜사이클리딘(PCP) 유도체입니다.
- 임상 효과: 깊은 체성 진통, 기억 상실, 시상피질계와 변연계의 해리를 특징으로 하는 강직 상태를 유발합니다. 전통적인 마취제와 달리 3기 마취를 유도하지 않습니다.
- 반사 유지: 환자는 일반적으로 인두, 후두, 각막 및 발 반사를 포함한 뇌신경 반사를 유지합니다. 눈은 종종 뜬 상태를 유지합니다.
- 심혈관계: 교감 신경 긴장을 증가시켜 일반적으로 심혈관계를 자극(심박수, 혈압 및 심박출량 증가)하므로 혈역학적으로 불안정한 환자에게 유용합니다(단, 비대성 심근병증에는 금기).
임상 요점: 케타민 단독 사용 시 근육 강직을 유발하고 내장 진통 효과가 부족하기 때문에, 원활한 유도, 적절한 근육 이완 및 부드러운 회복을 보장하기 위해 거의 항상 근육 이완제(예: 미다졸람 또는 디아제팜과 같은 벤조디아제핀) 또는 알파-2 작용제(예: 덱스메데토미딘, 킬라진)와 함께 투여됩니다.
작용 기전
Ketamine exerts its effects through multiple central nervous system pathways:
- NMDA Receptor Antagonism: Acts as a non-competitive antagonist at the N-methyl-D-aspartate (NMDA) receptor → binds to the PCP site inside the calcium channel pore → prevents glutamate-mediated calcium influx → blocks central sensitization and prevents the "wind-up" phenomenon associated with chronic or severe pain.
- Neurotransmitter Modulation: Inhibits GABA and blocks the reuptake of serotonin, norepinephrine, and dopamine in the CNS.
- CNS Dissociation: Depresses the thalamoneocortical system (responsible for sensory perception) while simultaneously activating the limbic system (involved in memory and emotion).
- Sympathetic Stimulation: Increases sympathetic tone by promoting norepinephrine release → leads to increased heart rate, cardiac output, and blood pressure. Note: Ketamine has direct negative inotropic effects on the myocardium, which are usually masked by this sympathetic surge unless the patient is catecholamine-depleted.
안전성·주의사항
금기사항
- Prior hypersensitivity reactions to ketamine
- Animals intended for human consumption
- Use as a sole agent for major surgery (due to poor muscle relaxation and visceral analgesia)
- Increased cerebrospinal fluid (CSF) pressure or head trauma
- Significant hypertension, heart failure, or arterial aneurysms
- Hypertrophic cardiomyopathy (HCM) in cats
- Increased intra-ocular pressure or open globe injuries (relative)
- Procedures involving the pharynx, larynx, or trachea (relative)
- Preexisting seizure disorders (use with extreme caution)
- Animals whose eyes are at risk of perforation
- Raised intraocular pressure (IOP)
- Raised intracranial pressure (ICP)
부작용
- Hypertension
- Hypersalivation
- Respiratory depression (at high doses or rapid IV administration)
- Hyperthermia (especially in cats)
- Emesis
- Vocalization
- Erratic and prolonged recovery (emergence delirium)
- Dyspnea
- Spastic jerking movements and muscular tremors
- Seizures (up to 20% of cats at therapeutic doses)
- Hypertonicity and opisthotonos
- Cardiac arrest
- Pain after IM injection
- Eyes remain open (risk of corneal drying/ulceration)
- Cardiovascular depression and arrhythmias (in animals with high sympathetic tone, shock, or severe CV disease)
- Tachycardia (following high IV doses)
- Marked respiratory depression (in some animals)
- Skeletal muscle hypertonicity and spontaneous movement (if used alone)
- Spacey, abnormal behaviour or dysphoria during recovery (1-2 hours)
- Drug accumulation and prolonged recovery (with prolonged infusion)
주의
Cardiovascular Caution: Ketamine increases heart rate, blood pressure, and myocardial oxygen consumption. Avoid in patients where this is detrimental (e.g., unstable shock, congestive heart failure, hypertrophic cardiomyopathy).
Ocular Care: Cats' eyes remain open after receiving ketamine. Protect from injury and apply an ophthalmic lubricant (e.g., Lacri-Lube) to prevent excessive corneal drying.
- Hepatic/Renal Insufficiency: Use with caution. In cats, ketamine is excreted almost exclusively via the kidneys; reduce doses or use cautiously in feline renal disease.
- Sympathetic Tone: Use with caution in animals with preexisting increased sympathetic tone (e.g., pheochromocytoma, hyperthyroidism).
- Recovery: Minimize exposure to handling or loud noises during the recovery period to reduce the incidence of emergence reactions (delirium, thrashing), but continue to monitor vital signs closely.
- Hemorrhage: Because ketamine can increase blood pressure, careful control of post-surgical hemorrhage (e.g., declawing) is required.
약물 상호작용
May prolong the anesthetic actions of ketamine
May prolong the recovery time after ketamine anesthesia
Recovery rates may be prolonged and the cardiac stimulatory effects of ketamine may be inhibited; close monitoring of cardiac status is recommended
Recommended not to use ivermectin in reptiles within 10 days of ketamine
May cause enhanced or prolonged respiratory depression
May induce severe hypertension and tachycardia; beta-blockers may be of benefit in treating these effects
Synergistic anaesthesia and prevention of muscle hypertonicity. Reversal of the alpha-2 agonist must be delayed until 45 minutes after ketamine administration to prevent unopposed ketamine excitation.
Synergistic anaesthesia and prevention of ketamine-induced skeletal muscle hypertonicity.
모니터링
- Level of anesthesia and analgesia
- Respiratory function
- Cardiovascular status (heart rate, rhythm, blood pressure)
- Eyes (monitor to prevent drying or injury)
- Body temperature (monitor for hyperthermia or hypothermia)
- Heart rate and rhythm
- Respiratory rate and depth
- Depth of anaesthesia
- Corneal lubrication status
- Quality of recovery (monitor for dysphoria)
약동학
반감기
흡수
After IM injection in the cat, peak levels occur in approximately 10 minutes. Sublingual spray in cats is absorbed enough to have pharmacologic action.
분포
Distributed into all body tissues rapidly, with highest levels found in the brain, liver, lung, and fat. Plasma protein binding is approximately 50% in the horse, 53% in dogs, and 37-53% in cats.
대사
In most species, metabolized in the liver principally by demethylation and hydroxylation. One active metabolite, nor-ketamine, has 10-30% of the activity of the parent compound. In cats, ketamine is almost exclusively excreted unchanged.
배설
Eliminated primarily in the urine. Redistribution out of the CNS is more of a factor in determining duration of anesthesia than is the elimination half-life.
과다투여
Ketamine has a wide therapeutic index (approximately 5 times greater than pentobarbital).
- Signs of Toxicity: When given too rapidly or in excessive doses, significant respiratory depression may occur.
- Treatment: Treatment using mechanically assisted respiratory support is recommended over the use of analeptic agents. In cats, yohimbine combined with 4-aminopyridine has been suggested for use as a partial antagonist.
제품
제형
- Injection: 10 mg/mL
- Injection: 50 mg/mL
- Injection: 100 mg/mL
- Injectable: 100 mg/ml solution
동물용의약품
- Ketamine HCl for Injection: 100 mg/mL in 10 mL vials (Ketaject, Ketaset, Keta-sthetic, Vetalar, VetaKet)
- Anaestamine 100 mg/ml injection
- Anesketin 100 mg/ml injection
- Ketaset 100 mg/ml injection
- Ketavet 100 mg/ml injection
- Narketan-10 100 mg/ml injection
- Vetalar-V 100 mg/ml injection
인용의약품
- Ketamine HCl Injection: 10 mg/mL in 20 mL vials
- Ketamine HCl Injection: 50 mg/mL in 10 mL vials
- Ketamine HCl Injection: 100 mg/mL in 5 mL vials (Ketalar)
규제 현황
POM-V CD SCHEDULE 2
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store between 15-30°C (59-86°F) and protect from light. Solution may darken upon prolonged exposure to light, which does not affect potency. Do not use if precipitates appear. Do not mix with barbiturates or diazepam in the same syringe or IV bag as precipitation may occur.
보호자 정보
중요: 케타민은 향정신성의약품(통제 약물)이며 임상 환경에서 수의학 전문가에 의해서만 투여됩니다.
- 눈 관리: 이 약물의 효과가 지속되는 동안 반려동물의 눈이 떠 있을 수 있습니다. 수의료진은 건조 및 손상을 방지하기 위해 보호용 안연고를 바를 것입니다.
- 회복기: 회복하는 동안 반려동물을 조용하고 어두운 환경에 두십시오. 약효가 떨어질 때 놀람 반응, 불규칙한 움직임 또는 환각을 방지하기 위해 큰 소리, 갑작스러운 움직임 및 과도한 만짐을 최소화하십시오.
- 주의 사항: 비정상적인 경련, 장기간의 몽롱함 또는 이상 행동이 있는지 관찰하고 수의사에게 보고하십시오.
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