What is the standard ketamine dose for procedural sedation?

For procedural sedation in the emergency department, the standard IV dose is 1–2 mg/kg administered over 1–2 minutes. The IM dose is 4–5 mg/kg. IV onset is typically 1–2 minutes with duration of 10–20 minutes. IM onset is 3–5 minutes with duration of 20–30 minutes. Additional doses of 0.5–1 mg/kg IV may be given if sedation is inadequate.

What is sub-dissociative dose ketamine for pain management?

Sub-dissociative (analgesic) dose ketamine is 0.1–0.3 mg/kg IV administered over 15 minutes, or 0.5–1 mg/kg intranasally. This low dose provides effective analgesia while avoiding dissociation. It is increasingly used in the ED as an opioid-sparing strategy for acute pain management.

Does ketamine raise intracranial pressure (ICP)?

The notion that ketamine raises ICP has been largely debunked. Multiple studies and a 2014 systematic review have shown that ketamine does not increase ICP in ventilated patients and may actually lower ICP while maintaining cerebral perfusion pressure. Ketamine is now considered safe for RSI in patients with traumatic brain injury.

Should I premedicate with an anti-sialagogue before ketamine?

Ketamine stimulates salivary secretions. While routine premedication is debated, glycopyrrolate 0.004 mg/kg IV (max 0.2 mg) or atropine 0.01 mg/kg may be given prophylactically, especially for IM sedation or in pediatric patients. Some experts reserve anti-sialagogues for cases where hypersalivation becomes clinically significant.

What is the ketamine dose for rapid sequence intubation (RSI)?

For RSI, ketamine is dosed at 1–2 mg/kg IV push (typically 1.5 mg/kg). It provides sedation, analgesia, and amnesia while preserving respiratory drive and hemodynamic stability. Ketamine is favored for hemodynamically unstable patients, severe asthma, and patients with sepsis because it supports blood pressure through catecholamine release.

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Ketamine Dose Calculator

Calculate ketamine dosing by clinical indication with volumes for common concentrations. Supports procedural sedation, RSI, sub-dissociative analgesia, status epilepticus, and more.

Inputs

Patient Weight

Indication

Route

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Enter weight to calculate ketamine dose.

Disclaimer: For educational purposes only. Always verify doses with your institution's formulary and pharmacy. Not a substitute for clinical judgment.

Contraindications & Cautions

⚠ Contraindications

Age <3 months — increased risk of airway complications
Known hypersensitivity to ketamine
Conditions with elevated ICP — use caution in unshunted hydrocephalus or mass lesions with midline shift
Severe uncontrolled hypertension — sympathomimetic effects
Acute psychosis / schizophrenia — may worsen symptoms
Globe injury — may transiently raise IOP

📋 ICP Myth Debunked

The historic concern that ketamine raises ICP has been largely refuted. A 2014 systematic review found no clinically significant ICP elevation in ventilated patients. Ketamine is now considered safe — even preferred — for RSI in TBI patients because it maintains cerebral perfusion pressure and hemodynamic stability.

Clinical Pearls

Emergence reactions: Occur in ~10–20% of adults (rare in children <10 years). Consider midazolam 0.03 mg/kg IV if emergence reaction occurs.
Respiratory: Ketamine preserves airway reflexes and respiratory drive. Apnea is rare and typically occurs only with rapid IV push.
Hemodynamics: Sympathomimetic — increases HR, BP. Ideal for hypotensive/septic patients. Avoid in aortic dissection.
Bronchodilation: Potent bronchodilator — excellent choice in severe asthma/bronchospasm.
Pediatric: Well-studied safety profile in children. IM is often preferred for uncooperative children.

References

Green SM, Roback MG, Kennedy RM, et al. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update. Ann Emerg Med. 2011;57(5):449-461.
Motov S, Mai M, Grunwald Z, et al. A prospective randomized, double-dummy trial comparing IV push low dose ketamine to short infusion of low dose ketamine for treatment of pain in the ED. Am J Emerg Med. 2017;35(8):1095-1100.
Andolfatto G, Abu-Laban RB, Zed PJ, et al. Ketamine-Propofol Combination (Ketofol) Versus Propofol Alone for Emergency Department Procedural Sedation and Analgesia. Ann Emerg Med. 2012;59(6):504-512.
Zeiler FA, Teitelbaum J, West M, et al. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care. 2014;21(1):163-173.

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About This Tool

What Is Ketamine?

Ketamine is a dissociative anesthetic agent that provides sedation, analgesia, and amnesia while uniquely preserving respiratory drive and airway protective reflexes. First synthesized in 1962, it remains one of the most versatile drugs in emergency medicine, anesthesia, and critical care. It acts primarily as an NMDA receptor antagonist and has additional effects on opioid, monoaminergic, and cholinergic receptors.

Dosing by Indication

Procedural Sedation: The most common emergency department use. IV dosing of 1–2 mg/kg (typically 1.5 mg/kg) administered over 1–2 minutes provides rapid dissociative sedation lasting 10–20 minutes. IM dosing of 4–5 mg/kg is useful when IV access is unavailable, with onset in 3–5 minutes and duration of 20–30 minutes. Additional IV doses of 0.5–1 mg/kg can be given at 5–10 minute intervals for prolonged procedures.

RSI / Intubation: Ketamine at 1–2 mg/kg IV (typically 1.5 mg/kg) is an excellent induction agent for rapid sequence intubation, particularly in hemodynamically unstable patients, severe asthma, and sepsis. Its sympathomimetic properties support blood pressure, making it ideal when propofol or etomidate may cause hypotension.

Sub-Dissociative Analgesia: Low-dose ketamine at 0.1–0.3 mg/kg IV administered over 15 minutes, or 0.5–1 mg/kg intranasally, provides effective analgesia without dissociation. This is increasingly used as an opioid-sparing strategy for acute pain, renal colic, fractures, and abdominal pain. Side effects at analgesic doses are generally mild (dizziness, dysphoria) and transient.

Status Epilepticus: For refractory status epilepticus, ketamine 1–3 mg/kg IV bolus followed by a continuous infusion of 0.5–4 mg/kg/hr is used as a third- or fourth-line agent. Its NMDA antagonism provides a unique mechanism of action against seizures that have not responded to GABA-ergic agents.

Depression (Off-Label): Sub-anesthetic ketamine at 0.5 mg/kg IV administered over 40 minutes has shown rapid antidepressant effects in treatment-resistant depression. This is typically administered in a monitored clinic setting.

Pediatric Sedation: Ketamine has an extensive safety record in pediatric procedural sedation. IV dosing is 1–2 mg/kg, IM is 4–5 mg/kg, and oral dosing is 6–10 mg/kg (mixed in a flavored beverage). Children under 10 years have lower rates of emergence reactions compared to adults.

Route Comparison

Route	Onset	Duration	Recovery
IV	1–2 min	10–20 min	60–120 min
IM	3–5 min	20–30 min	60–150 min
IN	5–10 min	30–60 min	60–120 min
PO	15–30 min	60–90 min	120–240 min

🔑 Clinical Pearls

Push speed matters: Administer IV ketamine over at least 1 minute. Rapid push increases the risk of transient apnea and laryngospasm.
Intranasal delivery: Use concentrated solution (100 mg/mL preferred) via mucosal atomization device (MAD). Max volume per nare is ~1 mL — split between nares if needed.
Emergence reactions: More common in adults, women, and with higher doses. A quiet, dim recovery environment reduces incidence. Benzodiazepines can treat but routine prophylaxis is controversial.
NPO status: Green et al. (2019) found that fasting is NOT required before ketamine sedation in the ED — emesis rate is 8–12% regardless of fasting status, and aspiration is exceedingly rare.

Key References

Green SM, et al. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update. Ann Emerg Med. 2011;57(5):449-461.
Motov S, et al. A prospective randomized, double-dummy trial comparing IV push low dose ketamine to short infusion of low dose ketamine. Am J Emerg Med. 2017;35(8):1095-1100.
Andolfatto G, et al. Ketamine-Propofol Combination (Ketofol) Versus Propofol Alone. Ann Emerg Med. 2012;59(6):504-512.

Formula last verified: February 2026