The Ketamine Spectrum with Sergey Motov & Ryan Marino: Part 1 Analgesic Dosing
Apr 4, 2023
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Experts Sergey Motov & Ryan Marino discuss ketamine's varied applications for pain control, emphasizing dosing, side effects, and adjuncts. They explore ketamine's pharmacologic profile, optimization in the ER, and managing side effects with medications like ondansetron. Dosing considerations for special populations, intranasal administration, and historical background are also covered.
Ketamine is a versatile analgesic option in emergency settings, manageable with proper dosing considerations and adjunct medications.
Maintaining lower doses of ketamine, adjusting for special populations, and utilizing alternative administration routes enhance analgesic outcomes.
Adjunct medications like ondansetron and haloperidol, along with dose adjustment strategies, aid in optimizing pain management with ketamine.
Deep dives
Ketamine as an Analgesic in the Emergency Department
Ketamine is a versatile and effective option for analgesia in the emergency department, offering a unique approach for pain management. It can be used alongside other medications like acetaminophen, NSAIDs, opioids, and nerve blocks or as a standalone treatment. Patient characteristics like allergies and pregnancy are crucial considerations, but apart from these, ketamine is a valuable tool for managing various types of pain.
Dosage and Administration Considerations
The dosing of ketamine plays a vital role in its effectiveness and safety for patients. Maintaining a lower spectrum of dosage, typically ranging from 0.1 to 0.3 mg/kg, administered primarily intravenously or subcutaneously, helps prevent dissociative effects. Strategies like pre-ketamine coaching, using short infusions over 15 to 20 minutes, and starting with lower doses enhance analgesic outcomes while minimizing adverse effects.
Special Populations and Alternative Administration Routes
In addressing special populations like the elderly and pediatric patients, ketamine dosing adjustments are necessary. For elderly patients, starting at lower doses like 0.15 mg/kg and scaling up if needed is recommended. Additionally, considering alternative administration routes such as intranasal, inhalation via nebulizer, and even oral ketamine in specific cases can provide effective pain management options.
Combating Side Effects and Enhancing Analgesic Efficacy
To mitigate side effects and optimize analgesic benefits, adjunct medications like ondansetron for nausea and vomiting, or haloperidol as a dopamine antagonist can be considered. Adjusting infusion rates, reassessing patient response post-infusion, and combining ketamine with appropriate medications based on receptor interactions can help achieve better pain management outcomes.
Future Discussions on Ketamine for Procedural Sedation and Chemical Takedowns
The podcast episode initiates a comprehensive discussion on the various applications of ketamine beyond analgesia, including its role in procedural sedation, rapid sequence intubation (RSI), and chemical takedowns. Stay tuned for part two to delve into these critical aspects of ketamine usage in medical interventions.
Ketamine is unique in its spectrum of use. From low dose ketamine for pain control to procedural sedation and analgesia, this drug is versatile, but needs to be used with care and attention to dosing, side effects, and adjuncts. Join us as we walk through the spectrum of use with true experts on the topic- Sergey Motov and Ryan Marino.
In Part 1 we focus on the use of Ketamine for Pain.