Intraoperative small-dose ketamine may therefore be a useful adjuvant to perioperative analgesic management.
Please describe your experiences.
https://www.asra.com/news/200/new-ketamine-guidelines-for-acute-and-ch
I could confirm (according to my current clinical practice) the beneficial effects of perioperative subanesthetic ketamine in upper gastroesophageal surgery, in lower abdominal surgery (colorectal and gynecological procedures), and in orthopedic limb procedures as well. And do recommend to see the attached file "Consensus Guidelines on the Use of Ketamine Infusions for Acute Pain Management ... - July 2018".
Hi Francesco. I would also recommend small subanesthetic doses of ketamine, specially in conditions where there is a possible psychosomatic component to the pain ( I will need corroboration from others on this observation). I have routinesly observed emergence delirium/ pain not responding to routine analgesics respond dramatically to small doses ( 10-20 mg) of ketamine.
Francesco,
I have used ketamine as part of a multimodal anesthetic for around 25 years now. My anesthetic practice rarely encompasses the use of opioids (in the last 18 months). Low dose ketamine (10-50mgs) replaces the need for 50-100 mcgs of fentanyl. Other providers patients whose pain are poorly controlled in the PACU, usually respond well to 10-20mgs ketamine IVP. Ketamine infusions are the cornerstone for my ERAS anesthetics.
Regards,
Christopher
Christopher A Smith thank you: how you manage your continuous infusion dosage ?
Francesco,
As part of an opioid free anesthetic (ketamine, dexmedetomidine, lidocaine and magnesium) , I administer 25-50mgs upon induction and start an infusion at 0.6mgs/kg/hr. Titration to effect with a goal under 0.2 by closing.
Cheers,
Christopher
Christopher A Smith whit this protocol what incidence of adverse events, related to infusion of ketamine, did you notice ?
Francesco,
Adverse events=0
occasional “strange dreams” =rare
zero respiratory events or reintubation
Significant reductions in opioid reductions
Cheers,
Christopher
I would like to suggest Barry Friedberg's work named opioid free anaesthesia based on propofol-ketaminw use. This protocol is very helpful.
Dear Dr. Francesco Calandese , I use it at PACU in paediatric patients. It works nice, but sometimes the nystagmus, caused by it, develope anxiety and agony for the parents who observe it live... which needs explanation to them. We use small dose of midazolam to reduce it. Very low dose IV Ketamine is excellent and economic adjuvant for the elderly following spine surgery and hip/knee replacement. It reduces many complications of opioids and provides early ambulation as well. Thanks.
Regards - Rabiul.
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