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

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Pdf Summary

This presentation explains the “enlightened” use of ketamine for hospitalized patients, especially for pain management. It begins with audience polling about how people view ketamine and whether their hospitals have ketamine policies.<br /><br />The talk covers ketamine’s history, chemistry, pharmacokinetics, and mechanisms of action. Ketamine was developed in the 1960s, approved by the FDA in 1970, and later adopted for subanesthetic pain control. It is a lipophilic drug available in racemic form for pain/anesthesia, with S-ketamine also used for depression. It can be given orally, topically, intranasally, intravenously, subcutaneously, rectally, or transdermally. The drug is metabolized in the liver.<br /><br />Ketamine’s pain-relieving effects are linked mainly to NMDA receptor antagonism, which may reduce neuropathic pain, opioid tolerance, and opioid-induced hyperalgesia. It also affects opioid, serotonin, dopamine, norepinephrine, and muscarinic pathways and may reduce cytokine production.<br /><br />The presentation reviews side effects and contraindications. Common adverse effects are dose-related and include psychomimetic effects, cardiovascular stimulation, and gastrointestinal symptoms. Important contraindications include psychosis, pregnancy, severe cardiovascular disease, elevated intracranial pressure, increased intraocular pressure, and significant liver disease.<br /><br />Evidence is presented for ketamine use in cancer pain, neuropathic pain, ischemic pain, sickle cell pain, and CRPS, though the presenter notes that larger randomized trials are still needed. Dosing strategies include low-dose subanesthetic infusions and oral or topical regimens, with medications like benzodiazepines, haloperidol, and glycopyrrolate used to manage side effects.<br /><br />The UNC policy section outlines indications, contraindications, required lab monitoring, infusion rates, and vital sign monitoring. The talk concludes with case examples showing dramatic pain relief and improved quality of life, reinforcing ketamine’s potential as a safe, opioid-sparing analgesic in selected hospitalized patients.

Keywords

ketamine

pain control

hospitalized patients

NMDA receptor

opioid-refractory pain

pharmacology

contraindications

low-dose infusion

UNC hospital policy

monitoring