Ketamine has experienced a clinical renaissance, with applications extending well beyond its traditional role as a dissociative anesthetic. Sub-anesthetic ketamine provides effective multimodal analgesia, opioid-sparing effects, and potential benefits in chronic pain states. Its unique hemodynamic profile makes it valuable for induction in hemodynamically compromised patients, though catecholamine-depleted states are an important exception.
NMDA receptor antagonist with analgesic, amnestic, and dissociative anesthetic properties
Induction dose: 1–2 mg/kg IV; analgesic dose: 0.1–0.5 mg/kg IV bolus or 0.1–0.3 mg/kg/hr infusion
Sympathomimetic effects: increases HR, BP, and cardiac output via catecholamine release
Preserves airway reflexes and spontaneous ventilation (though not a substitute for airway protection)
Sub-anesthetic doses reduce postoperative opioid consumption by 30–40% in multimodal regimens
For opioid-tolerant patients, administer ketamine 0.5 mg/kg IV at induction followed by 0.25 mg/kg/hr intraoperatively. This reduces postoperative opioid requirements and may attenuate opioid-induced hyperalgesia.
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