In the world of multimodal analgesia, ketamine is a wonderful drug with other pain medications (opioids, NSAIDs, etc.). It helps attenuate opioid-induced hyperalgesia, antagonizes NMDA receptors, and provides a state of disocciative amnesia.
I’ve not found a great consensus about how to dose ketamine intraoperatively as an analgesia adjunct. The literature quotes different doses for infusions and boluses, but here’s a simple formula which works for me assuming a non-ketamine induction of general anesthesia.
I bolus 0.5 mg/kg IV ketamine before incision, then bolus 0.2 mg/kg IV ketamine every 30 minutes until an hour before the end of the case. I’ve done this plenty of times in adult and pediatric patients with no significant emergence delirium and comfortable patients post-operatively. 🙂
How do you use ketamine intraoperatively?