Adverse Drug Effects and Preoperative Medication Factors Related to Perioperative Low-Dose Ketamine Infusions.
High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions and which ADEs most frequently led to discontinuation. Spine surgery was chosen because of its association with moderate to severe pain and a relatively high use of ketamine infusions in this population at our hospital.
From the *Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; †Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, CA; and ‡Department of Anesthesiology, University of Miami, Miami, FL.
Eric S
ES
Schwenk
Stephen F
SF
Goldberg
Ronak D
RD
Patel
Jon
J
Zhou
Douglas R
DR
Adams
Jaime L
JL
Baratta
Eugene R
ER
Viscusi
Richard H
RH
Epstein
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000778:Anesthetics, Dissociative / Q000008:administration & dosage / Q000009:adverse effects*; D001416:Back Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004347:Drug Interactions; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007649:Ketamine / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D007649:Ketamine