In July 2018, the American Society of Regional Anesthesia and Pain Medicine (ASRA), American Academy of Pain Medicine (AAPM), and American Society of Anesthesiologists (ASA) 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. In 1970, it was approved for use in humans in the United States. Since then, it has been utilized in operating rooms for both adult and children, as well as battlefields. It has gained prominence in medical literature over time 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 with 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 by the Regional Anesthesia and Pain Medicine journal, physician investigators outlined acceptable uses for IV ketamine. A group of patients undergoing invasive surgery might have an expected high level of pain post-operatively; according to the authors, they 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. The authors also 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.