Drug regimens for deep sedation

Note: Ketamine and propofol must only be administered by anaesthetists or other appropriately trained and credentialed medical practitioners.

If deep sedation is appropriate for an adult or child older than 2 years, the following drug regimens may be used; see Principles of deep sedation for a discussion of their use, including monitoring, equipment and physical facilities, and staffing requirements.

Ketamine and propofol must only be used for deep sedation by anaesthetists, or other appropriately trained and credentialed medical practitioners. In adults, ketamine and propofol are equal alternatives; in children, ketamine is preferred.

If ketamine is appropriate for deep sedation in adults or children older than 2 years, use:

1 ketamine 2.5 to 4 mg/kg intramuscularly, as a single dose, which is expected to provide between 5 and 20 minutes of analgesia and deep sedation. Use the lower end of the dose range in older or frail patients. Use ideal body weight in overweight patients procedural sedation and analgesia, deep sedation ketamine    

OR

1 ketamine 0.5 mg/kg intravenously, as a single dose. If necessary, give 0.5 mg/kg intravenously, every 2 minutes until adequate sedation and analgesia is achieved. A total dose of 1 to 1.5 mg/kg is usually required when ketamine is used as a single agent; lower doses may be sufficient for older or frail patients. Use ideal body weight in overweight patients. ketamine    

If propofol is appropriate for deep sedation in adults or children older than 2 years, use:

propofol 0.5 mg/kg intravenously, as a single dose. If necessary, give 0.5 mg/kg intravenously, every 2 minutes until adequate sedation and analgesia is achieved. A total dose of 1 to 1.5 mg/kg is usually required when propofol is used as a single agent; lower doses may be sufficient for older or frail patients. Use ideal body weight in overweight patients. procedural sedation and analgesia, deep sedation propofol    

During deep sedation, if an opioid is combined with ketamine for analgesia, use lower opioid doses than those outlined in conscious sedation, because ketamine and opioids have additive depressive effects on respiratory drive and airway reflexes. If an opioid is combined with propofol for analgesia, reduce the dose of propofol (above), because propofol and opioids have additive depressive effects on respiratory drive and airway reflexes.

Adding an opioid to ketamine or propofol for additional analgesia during deep sedation has additive depressive effects on respiratory drive and airway reflexes:

  • If an opioid is combined with ketamine, use lower opioid doses than those used for conscious sedation
  • If an opioid is combined with propofol, use the opioid doses for conscious sedation and reduce the above dose of propofol.

For opioid drug regimens for conscious sedation, see here for adults, and here for children.