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Archive September 2018 XIX, No. 9

Anesthesia Alert: 8 Little-Known Facts About Ketamine

Anesthetic and analgesic properties that make Special K special.

Arun Kalava

Arun Kalava, MD, DABA


CLINICAL UTILITY Ketamine is known as a popular recreational drug, but many studies support the role of sub-anesthetic ketamine as an anesthetic and an analgesic, says Dr. Kalava.

Ketamine's reputation as a date rape and party drug might scare your anesthesia providers off from using it. And that's a shame. Besides inducing anesthesia, ketamine also has significant analgesic properties. When administered at low doses before or during surgery, ketamine provides great intra- and post-op pain control — without hallucinations. Plus, it's a non-opioid that reduces morphine consumption and decreases pain scores. And unlike general anesthetics, ketamine won't cause a patient to stop breathing by suppressing the respiratory reflex.

Yes, there's a lot to like about ketamine. First, though, you must help your anesthesia providers and surgeons get past ketamine's Special K's reputation. These talking points might help.

1No hallucinations. Reports of hallucinations associated with ketamine's use go back to the 1960s. But here's the thing to remember: Hallucinations are based on dose. At a low dose, hallucinations are non-existent. I typically use a bolus of 0.5mg/kg. and follow with a 0.2-0.3 mg/kg/hr. infusion for cases longer than an hour. You don't have to worry about putting your patients in a dangerous spot at those doses.

2An anesthetic and an analgesic. Ketamine is a key part of our multimodal analgesia, which also includes acetaminophen, celecoxib, gabapentin, IV magnesium, lidocaine and ketorolac. These patients report pain levels of 0 on a scale of 1 to 10 and require little to no post-op opioids — including those who are opioid-dependent or opioid-tolerant.

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