Uses of Ketamine

Induction and Maintenance of General Anesthesia

1. Poor risk ASA IV (or V) patients with respiratory or cardiovascular disease (not CAD), especially reactive airway disease or hemodynamic compromise based on hypovolemia or intrinsic myocardial disease (not CAD)
2. Reactive airway disease, asthma
3. Rapid-sequence induction in otherwise healthy trauma victims after significant hemorrhage
4. Patients with septic shock *
5. Cardiac tamponade and restrictive percarditis (ketamine maintains heart rate and filling pressures)
6. Congenital heart disease, especially with propensity for R -> L shunt
7. Malignant hyperthermia susceptible patient with large anterior mediastinal mass when spontaneous ventilation was required during induction and intubation *
8. Cardiac anesthesia for correction of valvular or ischemic heart disease: ketamine, plus diazepam or midazolam * (maybe plus sufentanil*), by continuous infusion
   • minimal hemodynamic pertubations
   • profound analgesia
   • dependable amnesia
   • uneventful convalescence
9. Continuous infusion of ketamine plus propofol allows total intravenous anesthesia (TIVA) with profound analgesia and spontaneous ventilation

Sedation and Analgesia

1. Preoperative sedation/analgesia
2. Sedation (especially pediatric) away from the OR:
   • Cardiac catheterization
   • Radiation treatment
   • Radiologic studies
   • Dressing changes (e.g. post burn injury)
   • Dental procedures
3. During primary propofol sedation/anesthesia with spontaneous ventilation, ketamine boluses provide good analgesia (without respiratory depression) during injection of local anesthetics. *
4. Supplement to regional anesthesia, prior to or after block
5. Postoperative analgesia *

Other

1. Bronchodilation, treatment of status asthmaticus *
2. Inhibition of reflex hypertensive response to urinary bladder distension (rats) *
3. Treatment of restless leg syndrome * (ketamine 30-40 mg PO BID)
4. It has been suggested that ketamine may be useful as an adjunct to psychotherapy; e.g. it has been investigated as an aid in treatment of heroin addiction.

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