Practice Consideration

Ketamine Infusion (Practice Consideration)

Last AANA revision: 2024

Sub-anesthetic ketamine infusions (0.1–0.5 mg/kg/hr) reduce postoperative opioid requirements, improve pain in opioid-tolerant patients, and may prevent chronic post-surgical pain. Particularly useful for: spine surgery, thoracotomy, opioid-tolerant patients, complex regional pain syndrome.

Key points

1.Intraop bolus 0.25–0.5 mg/kg pre-incision + infusion 0.1–0.3 mg/kg/hr
2.Postop infusion 0.1–0.2 mg/kg/hr (PACU + ward, monitored bed)
3.Side effects: dissociation, vivid dreams, hypertension, salivation. Co-administer benzodiazepine for psychomimetic at higher doses.
4.Monitoring: ramsay sedation score, vital signs q4h, no separate cardiac monitoring needed at sub-anesthetic doses
5.Contraindications: severe CAD (relative — at sub-anesthetic doses minimal cardiac stress), uncontrolled HTN, psychosis history

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