In July 2018, the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine and the American Society of Anesthesiologists released the groundbreaking consensus guidelines for the use of IV ketamine in acute pain cases. Ketamine is an NDMA receptor antagonist that has a strong anesthetic effect. Ketamine was approved for use in humans in the United States in 1970. Since then, it has been utilized in operating rooms and the battle field. In hospitals, ketamine is considered safe for use in both pediatric and adult cases. In recent years, ketamine has gained prominence in medical literature as clinicians have explored its use for a variety of conditions such as treatment-resistant major depressive disorder (MDD), mood disorders, and post-traumatic stress disorder (PTSD). Evidence suggests that in small doses, ketamine can improve the symptoms of patients suffering from depressive disorders by affecting the glutamate neurotransmitter system.
Anesthesiologists, certified registered nurse anesthetists (CRNAs) and pain clinicians across the United States have increasingly started to administer ketamine to patients in acute and chronic pain. Given its safety, efficacy, and limited side effect profile, ketamine can serve as an effective drug for pain management.
Several major professional societies in the United States jointly developed guidelines for administering ketamine. In the guidelines, published in the journal Regional Anesthesia and Pain Medicine, physician investigators outlined acceptable uses for IV ketamine. The authors recommended that patients undergoing invasive surgery with a high level of pain expected post-operatively are good candidates for ketamine. In addition, the authors recommended that physicians consider patients who have tolerance or sensitivity/dependence to opioids as candidates for IV ketamine. Lastly, the authors identified several specific patient subgroups that could benefit from ketamine. These include patients with sickle cell disease, obstructive sleep apnea and those with the potential for opioid-related respiratory depression. For each segment, the guidelines recommend specific dosing protocols.
Anesthesia providers should consider incorporating IV ketamine into their current practice based on the recommended indications.