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shop quality and effective ketamine 100mg/ml

function or uses of shop quality and effective ketamine 100mg/ml online.

shop quality and effective ketamine 100mg/ml  is a medication primarily used for induction and maintenance of anesthesia. It induces dissociative anesthesia, a trance-like state providing pain reliefsedation, and amnesia.[19] The distinguishing features of ketamine anesthesia are preserved breathing and airway reflexes, stimulated heart function with increased blood pressure, and moderate bronchodilation.[19] At lower, sub-anesthetic doses, ketamine is a promising agent for pain and treatment-resistant depression.[20] However, the antidepressant action of a single administration of ketamine wanes with time, and the effects of repeated use have not been sufficiently studied.

Psychiatric side effects are frequent as well as raised blood pressure and nausea. Liver and urinary toxicity are common among regular users of high doses of ketamine for recreational purposes. Ketamine is an NMDA receptor antagonist and that accounts for most of its actions except the antidepressive effect, the mechanism of which is a matter of much research and debate.

shop quality and effective ketamine 100mg/ml was first synthesized in 1962 and approved for use in the United States in 1970. It was regularly used on dogs and horses and extensively used for surgical anaesthesia in the Vietnam War. Ketamine is also used as a recreational drug, both in powder and liquid form, often referred to as “Special K” for its hallucinogenic and dissociative effects.  It is on the World Health Organization’s List of Essential Medicines. It is available as a generic medication.

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shop quality and effective ketamine 100mg/ml

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Therapeutic indications of shop quality and effective ketamine 100mg/ml

Ketamine is indicated in children and in adults.

shop quality and effective ketamine 100mg/ml is recommended:

As an anaesthetic agent for diagnostic and surgical procedures. When used by intravenous or intramuscular injection, Ketamine is best suited for short procedures. With additional doses, or by intravenous infusion, Ketamine can be used for longer procedures. If skeletal muscle relaxation is desired, a muscle relaxant should be used and respiration should be supported.

For the induction of anaesthesia prior to the administration of other general anaesthetic agents. To supplement other anaesthetic agents.

Specific areas of application or types of procedures:

When the intramuscular route of administration is preferred.

Debridement, painful dressings, and skin grafting in burned patients, as well as other superficial surgical procedures.

Neurodiagnostic procedures such as pneumoencephalograms, ventriculograms, myelograms, and lumbar punctures.

Diagnostic and operative procedures of the eye, ear, nose, and mouth, including dental extractions.

Note: Eye movements may persist during ophthalmological procedures.

Anaesthesia in poor-risk patients with depression of vital functions or where depression of vital functions must be avoided, if at all possible.

Orthopaedic procedures such as closed reductions, manipulations, femoral pinning, amputations, and biopsies.

Sigmoidoscopy and minor surgery of the anus and rectum, circumcision and pilonidal sinus.

Cardiac catheterization procedures.

Caesarean section; as an induction agent in the absence of elevated blood pressure.

Anaesthesia in the asthmatic patient, either to minimise the risks of an attack of bronchospasm developing, or in the presence of bronchospasm where anaesthesia cannot be delayed.

shop quality and effective ketamine 100mg/ml

For intravenous infusion, intravenous injection or intramuscular injection.

Special warnings and precautions for use shop quality and effective ketamine 100mg/ml

To be used only in hospitals by or under the supervision of experienced medically qualified anaesthetists except under emergency conditions.

As with any general anaesthetic agent, resuscitative equipment should be available and ready for use.

Respiratory depression may occur with overdosage of shop quality and effective ketamine 100mg/ml, in which case supportive ventilation should be employed. Mechanical support of respiration is preferred to the administration of analeptics.

The intravenous dose should be administered over a period of 60 seconds. More rapid administration may result in transient respiratory depression or apnoea and enhanced pressor response.

Because pharyngeal and laryngeal reflexes usually remain active, mechanical stimulation of the pharynx should be avoided unless muscle relaxants, with proper attention to respiration, are used.

Although aspiration of contrast medium has been reported during shop quality and effective ketamine 100mg/mlanaesthesia under experimental conditions (Taylor, P A and Towey, R M, Brit. Med. J. 1971, 2: 688), in clinical practice aspiration is seldom a problem.

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shop quality and effective ketamine 100mg/ml

In surgical procedures involving visceral pain pathways, Ketamine should be supplemented with an agent which obtunds visceral pain.

When shop quality and effective ketamine 100mg/mlis used on an outpatient basis, the patient should not be released until recovery from anaesthesia is complete and then should be accompanied by a responsible adult.

Ketamine should be used with caution in patients with the following conditions:

– Use with caution in the chronic alcoholic and the acutely alcohol-intoxicated patient.

– shop quality and effective ketamine 100mg/ml is metabolised in the liver and hepatic clearance is required for termination of clinical effects. A prolonged duration of action may occur in patients with cirrhosis or other types of liver impairment. Dose reductions should be considered in these patients. Abnormal liver function tests associated with shop quality and effective ketamine 100mg/mluse have been reported, particularly with extended use (>3 days) or drug abuse.

– Since an increase in cerebrospinal fluid (CSF) pressure has been reported during Ketamine anaesthesia, Ketamine should be used with special caution in patients with preanaesthetic elevated cerebrospinal fluid pressure.

– Use with caution in patients with globe injuries and increased intraocular pressure (e.g. glaucoma) because the pressure may increase significantly after a single dose of ketamine.

– Use with caution in patients with neurotic traits or psychiatric illness (e.g. schizophrenia and acute psychosis)

– Use in caution in patients with acute intermittent porphyria.

– Use in caution in patients with seizures.

– Use in caution in patients with hyperthyroidism or patients receiving thyroid replacement (increased risk of hypertension and tachycardia)

– Use in caution in patients with pulmonary or upper respiratory infection (shop quality and effective ketamine 100mg/mlsensitises the gag reflex, potentially causing laryngospasm)

– Use in caution in patients with intracranial mass lesions, a presence of head injury, or hydrocephalus.

Emergence Reaction

The psychological manifestations vary in severity between pleasant dream-like states, vivid imagery, hallucinations, nightmares and emergence delirium (often consisting of dissociative or floating sensations). In some cases these states have been accompanied by confusion, excitement, and irrational behaviour which a few patients recall as an unpleasant experience..

Emergence delirium phenomena may occur during the recovery period. The incidence of these reactions may be reduced if verbal and tactile stimulation of the patient is minimised during the recovery period. This does not preclude the monitoring of vital signs.

Cardiovascular

Because of the substantial increase in myocardial oxygen consumption, ketamine should be used in caution in patients with hypovolemia, dehydration or cardiac disease, especially coronary artery disease (e.g. congestive heart failure, myocardial ischemia and myocardial infarction). In addition ketamine should be used with caution in patients with mild-to-moderate hypertension and tachyarrhythmias.

Cardiac function should be continually monitored during the procedure in patients found to have hypertension or cardiac decompensation.

Elevation of blood pressure begins shortly after the injection of shop quality and effective ketamine 100mg/ml, reaches a maximum within a few minutes and usually returns to preanaesthetic values within 15 minutes after injection. The median peak rise of blood pressure in clinical studies has ranged from 20 to 25 percent of preanaesthetic values. Depending on the condition of the patient, this elevation of blood pressure may be considered a beneficial effect, or in others, an adverse reaction.

Long-Term Use shop quality and effective ketamine 100mg/ml

Cases of cystitis including haemorrhagic cystitis have been reported in patients being given ketamine on a long term basis. This adverse reaction develops in patients receiving long term ketamine treatment after a time ranging from 1 month to several years. Ketamine is not indicated nor recommended for long term use. Hepatotoxicity has also been reported in patients with extended use (> 3 days).

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Drug Abuse and Dependence

shop quality and effective ketamine 100mg/ml has been reported as being a drug of abuse. Reports suggest that ketamine produces a variety of symptoms including, but not limited to, flashbacks, hallucinations, dysphoria, anxiety, insomnia, or disorientation. Cases of cystitis including haemorrhagic cystitis and cases of hepatotoxicity have also been reported. If used on a daily basis for a few weeks, dependence and tolerance may develop, particularly in individuals with a history of drug abuse and dependence. Therefore the use of shop quality and effective ketamine 100mg/ml should be closely supervised and it should be prescribed and administered with caution.

NOTE: All doses are given in terms of ketamine base

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Adults, elderly (over 65 years) and children:

For surgery in elderly patients ketamine has been shown to be suitable either alone or supplemented with other anaesthetic agents.

Preoperative preparations

shop quality and effective ketamine 100mg/mlhas been safely used alone when the stomach was not empty. However, since the need for supplemental agents and muscle relaxants cannot be predicted, when preparing for elective surgery it is advisable that nothing be given by mouth for at least six hours prior to anaesthesia.

Premedication with an anticholinergic agent (e.g. atropine, hyoscine or glycopyrolate) or another drying agent should be given at an appropriate interval prior to induction to reduce ketamine- induced hypersalivation.

Midazolam, diazepam, lorazepam, or flunitrazepam used as a premedicant or as an adjunct to ketamine, have been effective in reducing the incidence of emergence reactions.

Onset and duration

As with other general anaesthetic agents, the individual response to shop quality and effective ketamine 100mg/ml is somewhat varied depending on the dose, route of administration, age of patient, and concomitant use of other agents, so that dosage recommendation cannot be absolutely fixed. The dose should be titrated against the patient’s requirements.

Because of rapid induction following intravenous injection, the patient should be in a supported position during administration. An intravenous dose of 2 mg/kg of bodyweight usually produces surgical anaesthesia within 30 seconds after injection and the anaesthetic effect usually lasts 5 to10 minutes. An intramuscular dose of 10 mg/kg of bodyweight usually produces surgical anaesthesia within 3 to 4 minutes following injection and the anaesthetic effect usually lasts 12 to 25 minutes. Return to consciousness is gradual.

A. shop quality and effective ketamine 100mg/ml as the sole anaesthetic agent

Intravenous Infusion

The use of Ketamine by continuous infusion enables the dose to be titrated more closely, thereby reducing the amount of drug administered compared with intermittent administration. This results in a shorter recovery time and better stability of vital signs.

A solution containing 1 mg/ml of ketamine in dextrose 5% or sodium chloride 0.9% is suitable for administration by infusion.

General Anaesthesia Induction

An infusion corresponding to 0.5 – 2 mg/kg as total induction dose.

Maintenance of anaesthesia

Anaesthesia may be maintained using a microdrip infusion of 10 – 45 microgram/kg/min (approximately 1 – 3 mg/min).

The rate of infusion will depend on the patient’s reaction and response to anaesthesia. The dosage required may be reduced when a long acting neuromuscular blocking agent is used.

Intermittent Injection

Induction

Intravenous Route

The initial dose of Ketamine administered intravenously may range from 1 mg/kg to 4.5 mg/kg (in terms of ketamine base). The average amount required to produce 5 to 10 minutes of surgical anaesthesia has been 2.0 mg/kg. It is recommended that intravenous administration be accomplished slowly (over a period of 60 seconds). More rapid administration may result in respiratory depression and enhanced pressor response.

Dosage in Obstetrics

Intramuscular Route

The initial dose of shop quality and effective ketamine 100mg/ml administered intramuscularly may range from 6.5 mg/kg to 13 mg/kg (in terms of ketamine base). A low initial intramuscular dose of 4 mg/kg has been used in diagnostic manoeuvres and procedures not involving intensely painful stimuli. A dose of 10 mg/kg will usually produce 12 to 25 minutes of surgical anaesthesia.

Dosage in Hepatic Insufficiency:<)

Dosage in Obstetrics

Data are lacking for intramuscular injection and maintenance infusion of ketamine in the parturient population, and recommendations cannot be made.

Maintenance of general anaesthesia

Lightening of anaesthesia may be indicated by nystagmus, movements in response to stimulation, and vocalization. Anaesthesia is maintained by the administration of additional doses of Ketamine by either the intravenous or intramuscular route.

Each additional dose is from ½ to the full induction dose recommended above for the route selected for maintenance, regardless of the route used for induction.

The larger the total amount of Ketamine administered, the longer will be the time to complete recovery.

Purposeless and tonic-clonic movements of extremities may occur during the course of anaesthesia. These movements do not imply a light plane and are not indicative of the need for additional doses of the anaesthetic.

B. shop quality and effective ketamine 100mg/ml as induction agent prior to the use of other general anaesthetics

Induction is accomplished by a full intravenous or intramuscular dose of Ketamine as defined above. If Ketamine has been administered intravenously and the principal anaesthetic is slow- acting, a second dose of Ketamine may be required 5 to 8 minutes following the initial dose. If Ketamine has been administered intramuscularly and the principal anaesthetic is rapid-acting, administration of the principal anaesthetic may be delayed up to 15 minutes following the injection of Ketamine.

C. shop quality and effective ketamine 100mg/ml as supplement to anaesthetic agents

Ketamine is clinically compatible with the commonly used general and local anaesthetic agents when an adequate respiratory exchange is maintained. The dose of Ketamine for use in conjunction with other anaesthetic agents is usually in the same range as the dosage stated above; however, the use of another anaesthetic agent may allow a reduction in the dose of shop quality and effective ketamine 100mg/ml.

D. Management of patients in recovery

Following the procedure the patient should be observed but left undisturbed. This does not preclude the monitoring of vital signs. If, during the recovery, the patient shows any indication of emergence delirium, consideration may be given to the use of diazepam (5 to 10 mg I.V. in an adult). A hypnotic dose of a thiobarbiturate (50 to 100 mg I.V.) may be used to terminate severe emergence reactions. If any one of these agents is employed, the patient may experience a longer recovery period.

Pharmacodynamic properties of shop quality and effective ketamine 100mg/ml

Pharmacotherapeutic group: Other general anesthetics.

ATC Code: N01A X03

shop quality and effective ketamine 100mg/ml is a rapidly acting general anaesthetic for intravenous or intramuscular use with a distinct pharmacological action. Ketamine hydrochloride produces dissociative anaesthesia characterised by catalepsy, amnesia, and marked analgesia which may persist into the recovery period. Pharyngeal-laryngeal reflexes remain normal and skeletal muscle tone may be normal or can be enhanced to varying degrees. Mild cardiac and respiratory stimulation and occasionally respiratory depression occur.

Mechanism of Action:

shop quality and effective ketamine 100mg/ml induces sedation, immobility, amnesia and marked analgesia. The anaesthetic state produced by ketamine has been termed “dissociative anaesthesia” in that it appears to selectively interrupt association pathways of the brain before producing somesthetic sensory blockade. It may selectively depress the thalamoneocortical system before significantly obtunding the more ancient cerebral centres and pathways (reticular-activating and limbic systems). Numerous theories have been proposed to explain the effects of shop quality and effective ketamine 100mg/ml, including binding to N-methyl-D-aspartate (NMDA) receptors in the CNS, interactions with opiate receptors at central and spinal sites and interaction with norepinephrine, serotonin and muscarinic cholinergic receptors. The activity on NMDA receptors may be responsible for the analgesic as well as psychiatric (psychosis) effects of ketamine. Ketamine has sympathomimetic activity resulting in tachycardia, hypertension, increased myocardial and cerebral oxygen consumption, increased cerebral blood flow and increased intracranial and intraocular pressure. Ketamine is also a potent bronchodilator. Clinical effects observed following ketamine administration include increased blood pressure, increased muscle tone (may resemble catatonia), opening of eyes (usually accompanied by nystagmus) and increased myocardial oxygen consumption.

Undesirable effects and Overdose of shop quality and effective ketamine 100mg/ml

The following Adverse Events have been reported:

MedDRASystem Organ ClassFrequency†Undesirable Effects
Immune system disordersRareAnaphylactic reaction*
Metabolism and nutrition disordersUncommonAnorexia
Psychiatric disordersCommonHallucination, Abnormal dreams, Nightmare, Confusion, Agitation, Abnormal behaviour
UncommonAnxiety
RareDelirium* Flashback*, Dysphoria*, Insomnia, Disorientation*
Nervous system disordersCommonNystagmus, Hypertonia, Tonic clonic movements
Eye disordersCommonDiplopia
Not KnownIntraocular pressure increased
Cardiac disordersCommonBlood pressure increased, Heart rate increased
UncommonBradycardia, Arrhythmia
Vascular disordersUncommonHypotension
Respiratory, thoracic and Mediastinal disordersCommonRespiratory rate increased
UncommonRespiratory depression, Laryngospasm
RareObstructive airway disorder*, Apnoea*
Gastrointestinal disordersCommonNausea, Vomiting
RareSalivary hypersecretion*
Hepatobiliary disordersNot knownLiver function test abnormal, Drug-induced liver injury**
Skin and subcutaneous tissue disordersCommonErythema, Rash morbilliform
Renal and urinary disordersRareCystitis*, Haemorrhagic cystitis*
General disorders and administration site conditionsUncommonInjection site pain, Injection site rash

† Common (>1/100 to <1/10); Uncommon (>1/1,000 to <1/100); Rare (>1/10,000 to <1/1,000); Not known (frequency cannot be estimated from the available data)

* AE frequency estimated from post-marketing safety database

** Extended period use (> 3 days) or drug abuse

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Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme

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