Perioperative Ketamine Infusion

CA-2 · I.A.4.c.6 II.D.3.f.4 II.D.1.b.1.e

25Sources
6Kept
0Dropped

1 · Find evidence

PubMed query

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25 candidate papers

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Same-day build

PubMed query

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2 · Teaching points

Source

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6 points

The ASRA/AAPM/ASA consensus guideline supports ketamine for acute pain as a stand-alone treatment and as an adjunct to opioids, with contraindications similar to those for chronic pain. PMID 29870457 kept
Across 130 trials and 8,341 patients, perioperative ketamine cut 24-hour opioid consumption by about 8 mg morphine equivalents — roughly 19% — with bolus doses mostly 0.25 to 1 mg and infusions 2 to 5 micrograms per kilogram per minute. PMID 30570761 kept
In the PODCAST trial a single subanaesthetic dose of ketamine did not reduce delirium in older adults after major surgery (19.5% versus 19.8%) and increased hallucinations and nightmares with rising dose. PMID 28576285 kept
Ketamine's relationship with delirium is U-shaped: cumulative doses at or below 0.35 mg/kg were associated with less delirium, higher doses with none, and the minimum risk fell at 0.25 to 0.34 mg/kg. PMID 40619168 kept
In patients already taking opioids, ketamine reduced cumulative opioid consumption by roughly 97 mg at 24 hours and lowered sedation, while the effect on pain intensity itself was small and low-certainty. PMID 35065394 kept
In opioid-dependent patients having lumbar fusion, intraoperative S-ketamine reduced 24-hour morphine consumption from 121 mg to 79 mg and reduced sedation, without more hallucinations or nightmares. PMID 28067693 kept

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