Ketamine-- how to prepare patients?

[u/rainbowsforeverrr]

Hi folks, ER nurse here. I'm curious how you talk to patients about ketamine admin for procedures or for intractable pain relief. I give it fairly often but I still haven't found the right way to prepare patients (or parents of littles) for the psychotropic effects. I've never used ketamine personally, but it seems to be a very intense experience that ought to be part of the informed consent conversation. What is our ethical obligation?

[u/Negative_Way8350]

I tell them, "You may feel quite strange. This is normal. I promise you're safe." I don't tell them they may hallucinate because that may not happen and it freaks people out. I explain that they'll feel like they're dreaming and not remember the procedure. 

If they're cooperative, I offer to help them visualize something calming beforehand so it may influence their hallucinations. One patient told me he was walking through an empty train tunnel. I asked him more about that. He seemed quite content. 

For patients who start to get agitated, soothing piano or classical music played on my phone helps, as does turning down the lights. 

If people cry or become emotional, I remind them that their natural barriers are down and this is normal. I try not to have family in the room if at all possible. Because the patient appears to be lucid, they're often distressed by how the patient reacts. 

[u/MrPBH → u/Negative_Way8350]

Good framing.

I like to tell them that many people experience "waking dreams" when entering and exiting ketamine sedation. I think the connotation of "dream" is much more benign than that of "hallucination."

Dream suggests a heavenly environment and peace. Hallucination brings to mind images of hell and suffering.