Questions · Perioperative Ketamine Infusion
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Recall — derived from a kept point
The ASRA/AAPM/ASA consensus guideline addresses intravenous ketamine infusions for acute pain. In one or two sentences, state the two roles in which that guideline supports ketamine for acute pain, and how it characterizes ketamine's contraindications relative to those for chronic pain use.
Answer: The consensus guideline supports ketamine for acute pain both as a stand-alone treatment and as an adjunct to opioids, and it states that the contraindications are similar to those for chronic pain.
Ketamine is endorsed by that consensus document in both roles, stand-alone and opioid adjunct, and you screen for the same contraindications you would apply in the chronic pain setting.
Source claim: 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.
Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Acute Pain Management From the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists, Regional anesthesia and pain medicine 2018
recall · CA-1 · phrased by llm
A randomized, blinded trial gave intraoperative S-ketamine to opioid-dependent patients undergoing lumbar spinal fusion. State what happened in that trial to 24-hour morphine consumption (give both values), to sedation, and to hallucinations and nightmares.
Answer: Intraoperative S-ketamine reduced 24-hour morphine consumption from 121 mg to 79 mg and reduced sedation, without an increase in hallucinations or nightmares.
In that opioid-dependent fusion population the trial showed a roughly 40 mg morphine reduction over 24 hours and less sedation, with no excess hallucinations or nightmares.
Source claim: 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.
Intraoperative Ketamine Reduces Immediate Postoperative Opioid Consumption After Spinal Fusion Surgery in Chronic Pain Patients With Opioid Dependency: A Randomized, Blinded Trial, Pain 2017
recall · CA-2 · phrased by llm
A systematic review and meta-analysis of perioperative ketamine in patients with preoperative opioid intake reported a large reduction in cumulative opioid consumption. A resident concludes from it that ketamine clearly makes these patients hurt less. Using only what that meta-analysis reported, state what it actually found for opioid consumption, sedation, and pain intensity, and comment on the certainty of the pain finding.
Answer: It found that ketamine reduced cumulative opioid consumption by roughly 97 mg at 24 hours and lowered sedation, but the effect on pain intensity itself was small and low-certainty, so the resident's conclusion overstates it: the robust signal is opioid sparing, not a demonstrated meaningful reduction in pain scores.
Opioid-sparing and less sedation are what this meta-analysis supports in opioid-tolerant patients; the effect on pain intensity itself was small and low-certainty, so do not promise the patient less pain on this evidence.
Source claim: 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.
Perioperative Ketamine for Postoperative Pain Management in Patients With Preoperative Opioid Intake: A Systematic Review and Meta-Analysis, Journal of clinical anesthesia 2022
recall · CA-3 · phrased by llm
In the PODCAST trial, older adults having major surgery received a single subanaesthetic dose of ketamine intraoperatively. State the trial's finding for postoperative delirium, giving both event rates, and state what happened to hallucinations and nightmares as the dose rose.
Answer: A single subanaesthetic dose of ketamine did not reduce delirium in older adults after major surgery, 19.5% versus 19.8%, and hallucinations and nightmares increased with rising dose.
PODCAST is the reason not to give ketamine for delirium prevention: no reduction in delirium at all, and more hallucinations and nightmares as the dose went up.
Source claim: 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.
Intraoperative Ketamine for Prevention of Postoperative Delirium or Pain After Major Surgery in Older Adults: An International, Multicentre, Double-Blind, Randomised Clinical Trial, Lancet (London, England) 2017
recall · CA-2 · phrased by llm
Across 130 trials and 8,341 patients, perioperative ketamine cut ___-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.
Answer: 24
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.
Perioperative Intravenous Ketamine for Acute Postoperative Pain in Adults · PMID 30570761
recall · CA-2 · phrased by derived
Ketamine's relationship with delirium is U-shaped: cumulative doses at or below ___ mg/kg were associated with less delirium, higher doses with none, and the minimum risk fell at 0.25 to 0.34 mg/kg.
Answer: 0.35
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.
Dose-Dependent Relationship Between Intra-Operative Ketamine Administration and Postoperative Delirium: A Retrospective Cohort Study · PMID 40619168
recall · CA-2 · phrased by derived
The point with one number taken out. No model wrote any of this: the stem is the sentence you reviewed, minus a digit, and the paper it came from is named beneath it.
Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.