The "Enlightened" Use of Ketamine in Hospitalized Patients - The What, When, Why, Where, How!-Presentation

Video Transcription

Video Summary

The speaker, a hospitalist and palliative care physician, argues that ketamine is an underused but very safe option for pain management. She opens with a case of a patient with metastatic rectal cancer whose severe opioid-refractory pain and constipation might have been helped by ketamine. That experience motivated her advocacy for ketamine policy development.<br /><br />She reviews ketamine’s history, pharmacology, and uses: it is a World Health Organization essential drug, acts mainly through NMDA receptor blockade, and also has opioid-sparing, anti-hyperalgesic, and anti-inflammatory effects. At analgesic doses, common side effects are mild psychomimetic symptoms, nausea, and occasional cardiovascular changes; many traditional contraindications are dose-related and less relevant at sub-anesthetic dosing.<br /><br />The talk summarizes the evidence for cancer pain, sickle cell crises, neuropathic and ischemic pain, noting that randomized trials are small and sometimes conflicting, but case reports and guidelines support use. She describes dosing ranges, routes of administration, and a ketamine policy developed at UNC that expanded access from ICU-only use to floors and palliative care.<br /><br />She ends with a success story: a patient with metastatic breast cancer had dramatic pain relief and regained function on IV then oral ketamine, reinforcing her central message: why not use ketamine more often when it can reduce opioid burden and improve comfort?

Keywords

ketamine

pain management

palliative care

opioid-refractory pain

cancer pain

NMDA receptor blockade

opioid-sparing

sickle cell crisis

ketamine policy