SRNAs/CRNAs-Ketamine coming into vogue?

deepz · Oct 31, 2003

Originally posted by Athlein
Hey y'all,
Can anyone support or refute the anecdotal evidence that Ketamine is finding its way into fashion?
Has anyone run across any recent publication regarding ketamine?
Is anyone using ketamine in sub-therapeutic doses in outpatientsurgery settings?
TIA!

INTO fashion? Did it ever leave?

http://www.doctorfriedberg.com/testimonials.htm

BTW, I now include a 30-50 mg bolus of ketamine early on in the course of most GAs for the NDMA blocking action to minimize postop narc requirement and all the urps, etc.

Zee_RN, BSN, RN · Oct 31, 2003

We used ketamine for the first time in our ICU for a patient in DTs. It was given by an anesthesiologist resident. Never heard of it (in our setting at least) before [being an ICU RN, not an CRNA or any such individual :)].

bwt02 · Oct 31, 2003

We occasionally use it to debride wounds. Our facility requires an anesthesia provider to be in the unit (Burn/ICU) during it's administration.

Tenesma · Oct 31, 2003

ketamine was all the excitement when it came out - the perfect anesthetic drug... that soon lost its steam.... primarily because of the psych. issues involved (even despite benzo pre-treatment) that sometimes appear 2-4 weeks after the anesthetic...

i think ketamine does have its role in anesthesia but it will be a while before it becomes everything that some proponents believe it should be (ie: dr. friedberg)...

btw, ketamine is not an appropriate treatment for DTs - in fact it can lower seizure thresholds and worsen the situation. there must be more to that story ....

some patients i wouldn't use ketamine in are: brain injury, coronary disease, unstable angina, etc...

however it is unbelievable handy to take down a 220lbs mentally retarded who is combative :)

and it has a great role in "balanced anesthesia" especially when you want to run light on narcotics due to pulmonary/airway issues (ie: 650lbs patient w/ severe emphysema FEV1=550cc, difficult airway, unable to mask ventilate, but moderately difficult to intubate for a gastric bypass surgery!)

Athlein · Oct 31, 2003

DeepZ - Thanks for the reply. Very interesting link! This is the first I have heard of PK anesthesia. Any PONV with this reduced dose?

Tenesma - Also thanks for the reply. I've used ketamine in the exact population you describe while a bedside nurse in pediatrics. I just spoke with an MDA who chose ketamine for his own GA during outpatient surgery. He is a proponent of guided imagery with induction, and he said that he had a blissful time with no PONV or emergence reaction. Interesting.

To all - how about more clinical chat like this? Any interesting cases you could share/tricky questions/random factoids?

g8rlimey · Oct 31, 2003

It seems that the clinical chat waxes and wanes on this site, but I for one would love to see more, especially now that I can partially participate. Right now, I essentially don't know my a** from a hole in the ground secondary to no clinical experiences yet. We have a 3 day visit to the OR in December, then we have once a week next semester. From there it continues to increase.

OGP has a quite a bit of clinical chat on it, and it would be great if we could some of those folks to start posting over here (I know many are lurkers).

EmeraldNYL, BSN, RN · Oct 31, 2003

Unfortunately ketamine is so widely abused. It was the drug of choice for many at the first college I attended.

yoga crna · Nov 1, 2003

I use ketamine frequently in my plastic surgery cases that I do under sedation. It is a good analgesic and works well when the local is inadequate or wearing off. While I don't like to give recipes, a good technique for many of my patients is a ratio of propofol 200 mg, ketamine 50 mg and fentanyl 100 ug mixed together (mix very well) and use with an infusion pump or on a mini-drip. I believe all ketamine should be covered with an adequate dose of benzodiazepine, so the patient doesn't have a bad experience.

When ketamine first came on the market, we used much higher doses and had to essentially isolate the patients in recovery, to keep external stimuli to a minimum. I still like soft music and a quiet operating room on my ketamine cases.

In my opinion, ketamine is like propofol and should only be administered by anesthesia professionals.

YogaCRNA

Diprivan/Vented · Nov 3, 2003

I remember hearing that Ketamine created holes in your brain, but I think that's only if you use it frequently. I also remember hearing about people who had used it for recreational purposes going into psychotic episodes. I think a brief psych assessment would be called for if you were going to use this.