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No hallucinations. Reports of hallucinations associated with
ketamine's use go back to the 1960s. But here's the thing to
remember: Hallucinations are based on dose. At a low dose, hallucina-
tions are non-existent. I typically use a bolus of 0.5mg/hr and follow
with a 0.2 to 0.3 mg/kg/hr infusion for cases longer than 1 hour. You
don't have to worry about putting your patients in a dangerous spot at
those doses.
An anesthetic and an analgesic. Ketamine is a key part of our
multimodal analgesia regimen, which also includes acetamino-
phen, celecoxib, gabapentin, IV magnesium, lidocaine and ketorolac.
Patients report pain levels of 0 on a scale of 1 to 10 and require little to
no post-op opioids — including those who are opioid-dependent or
opioid-tolerant.
It's a non-opioid. As providers, we have a responsibility to do
what we can to curb the opioid crisis. Frighteningly, from 1999 to
2014, more than 165,000 people died from overdose related to opioid
pain medication in the United States, according to the Centers for
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on to surgery and which should be held back for further testing
based on risk factors. You can green-light patients who have
fewer than 2 of these risk factors: significant cardiovascular dis-
ease, previous myocardial infarction, arrhythmias, congestive
heart failure, pulmonary disease, history of deep venous throm-
bosis, diabetes or chronic renal disease. Advise patients with
more than 2 risk factors to get an echocardiogram before you
schedule them for surgery.
— Jeannette Sabatini
