KETAMINE IS A PHENCYCLIDINE DERIVATIVE THAT HAS BEEN IN CLINICAL USE ALL OVER THE WORLD SINCE THE 1960S. IT IS A POTENT NMDA RECEPTOR ANTAGONIST AND HAS BEEN USED AS AN INTRAVENOUS GENERAL ANESTHETIC AGENT DURING MOST OF ITS CLINICAL EXISTENCE.
RECENTLY, KETAMINE IN SUB-ANESTHETIC DOSES HAS FOUND A NICHE IN THE TREATMENT OF BOTH ACUTE AND CHRONIC PAIN. AT LOW DOSES, KETAMINE HAS AN OPIOID-SPARING EFFECT THAT POTENTIATES THE ANALGESIC EFFICACY OF OPIOIDS THEREBY REDUCING THE DOSE OF OPIOID NEEDED FOR PAIN RELIEF. THIS OPIOID REDUCTION TRANSLATES INTO OPIOID SIDE-EFFECT REDUCTION AND MAKES ACUTE PAIN MANAGEMENT SAFER. THE RISK OF RESPIRATORY DEPRESSION IS REDUCED, AS WELL AS OPIOID-INDUCED NAUSEA AND VOMITING, SEDATION, CONSTIPATION, URINARY RETENTION AND PRURITIS.
THE ACUTE PAIN SERVICE RECOMMENDS THE CONSIDERATION OF SUBANESTHETIC INFUSION OF KETAMINE INTRAOPERATIVELY DURING OPERATIONS WHERE POST-OPERATIVE PAIN IS KNOWN TO BE PROBLEMATIC. WE ALSO RECOMMEND THE INTRAOPERATIVE USE OF KETAMINE FOR PATIENTS WHO ARE ON CHRONIC OPIOID THERAPY PRIOR TO THEIR OPERATION. THE SERVICE WILL ALWAYS BE AVAILABLE TO CONSULT WITH THE PRIMARY ANESTHESIA TEAM IN THE OPERATING ROOM.
POST-OPERATIVELY, PATIENTS WITH HIGH OPIOID REQUIREMENTS MAY BE STARTED ON A KETAMINE INFUSION IN THE PACU OR IN THEIR HOSPITAL ROOM. DOSES BELOW 20 MG PER HOUR MAY BE RUN ON ANY FLOOR, WHILE DOSES 20 MG PER HOUR OR HIGHER REQUIRE A MONITORED BED.
TYPICALLY, THE ACUTE PAIN SERVICE WILL START PATIENTS AT 10 MG PER HOUR AND TITRATE THE DOSE ACCORDINGLY. SOME PATIENTS WILL NEED A BENZODIAZEPINE SUCH AS LORAZEPAM OR DIAZEPAM TO CONTROL SOME OF THE SIDE EFFECTS THAT CAN OCCUR FROM KETAMINE. THESE MAY INCLUDE HALLUCINATIONS OR DREAMS, BUT RARELY OCCUR AT THE LOW DOSES USED TO COUNTERACT OPIOID TOLERANCE AND HYPERALGESIA.
THE ACUTE PAIN SERVICE WILL INITIATE AND MANAGE ALL KETAMINE INFUSIONS AT STONY BROOK UNIVERSITY MEDICAL CENTER. THE SERVICE WILL IDENTIFY PATIENTS WHO WILL BENEFIT AND EXPLAIN THE RISKS AND BENEFITS TO THE PATIENT AND NOTIFY THE PRIMARY TEAM.
SBUMC KETAMINE POLICY STATEMENT
SBUMC KETAMINE ORDER FORM