A U G U S T 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 3 1
5. Understand the risks
All medications must have a risk-to-benefit ratio. While most providers are
aware of common concerns for acetaminophen (liver dysfunction) and NSAIDs
(renal disease, ulcers, bleeding), fewer are familiar with gabapentin-type drugs
and ketamine.
Gabapentin-type drugs can be associated with increased somnolence and
should be avoided in patients with high BMIs or known obstructive sleep apnea.
Additionally, they may cause confusion in the elderly, although this can be diffi-
cult to distinguish from opiate-related confusion. Also, both NSAIDs and
gabapentin-type drugs should be avoided if renal disease is present in the
patient.
Although ketamine is a still a fairly new medication to outpatient surgery, it
has received a great deal of press for its efficacy in small analgesic doses for
procedures in the emergency department. While it has very few contraindica-
tions, it must be emphasized that it is small, analgesic doses — not large, anes-
thetic doses — that are needed for an adequate result.
OSM
Dr. Wilson (wilsosh@musc.edu) is an associate professor, chief of
regional anesthesia pain service and regional anesthesia fellowship
director at the Medical University of South Carolina in Charleston, S.C.
