what is ketamine used for in surgery

Ketamine Uses in Surgery: Anesthetic Insights

Ketamine hydrochloride, also known as ketamine, is a drug approved by the FDA for surgery. It can be used alone or with other drugs. This medication works well for short surgeries that don't need muscle relaxation. It also helps in making patients ready for general anesthesia.

Ketamine is approved to make other drugs like nitrous oxide work better. This makes it a key choice for anesthesiologists. The Society of Critical Care Medicine says ketamine is great for quick intubation, especially in patients with breathing problems¹.

Ketamine is versatile in age range, starting from 3 months. Younger kids might need more of it because they metabolize faster¹.

Ketamine is not just for anesthesia. For pain, low-dose ketamine can be used alone or with other pain medicines. This is a good option for people with acute or chronic pain¹.

Research also looks at ketamine for mental health. It might help treat depression and suicidal thoughts that don't respond to other treatments. A special form of ketamine, called esketamine, is FDA-approved for this purpose¹.

Ketamine works by blocking certain receptors in the brain. It takes about 1 to 1.5 mg/kg by vein or 3 to 4 mg/kg by muscle to start affecting consciousness. It keeps breathing and swallowing reflexes normal and helps with heart and breathing rates¹.

Key Takeaways:

• Ketamine is an FDA-approved general anesthetic used in surgery and can be administered alone or in combination with other medications.
• Ketamine enhances the effects of low-potency substances like nitrous oxide and is recognized as an effective medication for rapid sequence intubation, especially in patients with bronchospasm.
• Ketamine can be used in a wide age range, starting from 3 months. Children may require higher dosing due to their faster metabolism.
• Low-dose ketamine is utilized for pain management either alone or in combination with other pain relief medications.
• Ketamine is being researched for potential applications in psychiatry, including treatment-resistant depression and suicidal ideation. Esketamine, a chemically similar drug, has been approved as a treatment for treatment-refractory depression.
• Ketamine operates as a noncompetitive NMDA and glutamate receptor antagonist, blocking HCN1 receptors. Its critical threshold for producing a dissociative state is around 1 to 1.5 mg/kg intravenously or 3 to 4 mg/kg intramuscularly.
• Ketamine generally maintains normal pharyngeal and laryngeal reflexes, permits spontaneous respiration, and enhances cardiovascular and respiratory stimulation.
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FDA-Approved Indications for Ketamine

• Ketamine is a medicine approved by the FDA for many uses in surgery. It works as a general anesthetic, alone or with other drugs, based on the surgery's needs². This drug is great for short surgeries that don't need muscle relaxation. It also helps start general anesthesia when used with other drugs². Plus, it boosts the effects of nitrous oxide in some surgeries².

  Ketamine is known for being safe. Studies with over 10,000 patients showed it's effective³. Doctors and surgeons rated its performance highly, calling it "excellent" or "good" in most cases³. Most procedures were found to have "adequate" anesthesia with ketamine³

• Rating	Anesthesiologist	Surgeon
  "Excellent" or "Good"	90%	93%
  "Fair"	6%	4%
  "Poor"	4%	3%

  About 12% of patients might have emergence reactions with Ketalar, but this is rare in those over 65³. Even accidental overdoses of Ketalar usually lead to full recovery³.

  Ketamine is a key drug in surgery, known for its effectiveness and safety. Its wide use shows how valuable it is for anesthesiologists and surgeons.

Off-Label Uses of Ketamine in Surgery

Ketamine is used off-label in surgery for more than just being a general anesthetic. It helps with sedation, pain control, and in cases where other treatments don't work. This shows how versatile and beneficial ketamine can be in surgery.

Sedation and Bronchospasm:

In emergencies, ketamine is often chosen for quick sedation, especially for those with bronchospasm. It helps open up the airways, making it easier to manage breathing. This makes ketamine a key tool in emergency situations⁴.

Pain Management:

Ketamine is key in easing pain after surgery. It's used for pain from injuries, broken bones, and other surgical procedures. By adding ketamine to pain treatment plans, doctors can help patients recover faster and feel better⁴.

Refractory Status Epilepticus:

For seizures that don't stop, ketamine might be a new treatment option. Research in 2015 showed promising results. More studies are needed to confirm its effectiveness in these cases⁵.

Treatment-Resistant Depression:

Ketamine is also being explored for treating depression that doesn't respond to usual treatments. Even before the FDA approved a ketamine nasal spray, doctors were using it for depression. Studies in 2017 found it could quickly help some people with severe depression⁵.

Potential Future Applications:

Research is looking into more ways ketamine could be used in surgery and mental health. A 2017 trial suggested it might help with social anxiety. Ongoing studies aim to understand ketamine's full potential⁵.

Note: The image above represents the varied off-label uses of ketamine in surgical settings.

Off-Label Uses of Ketamine in Surgery	Statistical Data Reference
Procedural sedation and bronchospasm	4
Pain management in surgery	4
Refractory status epilepticus treatment	5
Treatment-resistant depression	5
Potential future applications	5

Conclusion

Ketamine is a key player in modern surgery, known for its fast action and quick recovery times. It's approved by the FDA for general anesthesia in many surgeries. But it's also used off-label for more than just pain and breathing issues⁶. It's showing promise in treating depression and suicidal thoughts, making it a big deal in mental health care⁶.

For nearly 50 years, ketamine has been a trusted choice in the operating room⁷. It's safe and effective, especially for kids, people with asthma, and those with unstable heart conditions or having C-sections⁷. At lower doses, it can prevent more pain and reduce the need for opioids⁷. It also cuts down on post-op nausea and vomiting⁷.

But, ketamine isn't without its risks. Using it illegally can lead to serious health problems like bladder issues, kidney damage, and stomach problems⁷. Studies suggest it could harm the developing brain in animals⁷. We must think carefully about these risks when using ketamine in medicine.

FAQ

What is ketamine?

Ketamine hydrochloride, known as ketamine, is a drug approved by the FDA. It's used as a general anesthetic in surgery. It works well for short medical procedures that don't need muscle relaxation. It also helps induce general anesthesia before surgery.

What are the FDA-approved indications for ketamine?

The FDA has approved ketamine for general anesthesia in surgery. It can be used alone or with other drugs. It also boosts the effects of nitrous oxide, another drug.

What are the off-label uses of ketamine in surgery?

Ketamine is used off-label for short-term sedation in surgery and for quick intubation in emergencies. It helps manage pain after injuries, fractures, and in the abdomen, back, and legs. It may also help with depression and suicidal thoughts, but it needs FDA approval for these uses.

What is the role of ketamine in surgery?

Ketamine is crucial in surgery for its fast action and quick recovery. It relieves pain, sedates patients, and makes anesthesia work better. It's a good choice for people with breathing problems because it helps open up the airways.