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/caffeinated_humanoid]

I agree with you about glorifying the drug in that way. However, I avoid telling patients that they will not remember it. Ketamine doesn't reliably cause amnesia in my experience (but I also don't like to use it alone).

[u/MrPBH → u/caffeinated_humanoid]

If dosed properly, it pretty reliably obliterates consciousness. Most of my ketamine sedation patients cannot recall the events during dissociation, aside from a vague sense of existing in the same room. Even those who are yelling and screaming don't recall doing so when they come to.

Contrast that with benzos, which will produce amnesia even at anxiolytic doses. Ketamine is a very dose dependent drug and low doses work qualitatively different from high doses.

Sub dissociative doses of ketamine are not amnestic and can cause a lot of trauma. That's why I don't like "pain dose" ketamine. It's enough to cause an unpleasant experience, but not enough to cause dissociation, so you remember that unpleasant experience.

[u/Equivalent-Lie5822 → u/MrPBH]

I got midazolam for a procedure once- I always thought versed was weak sauce until I got it myself. Man, oh man. Apparently I was aggressively hitting on the anesthesiologist (telling him I don’t have a gag reflex). I have zero recollection of that. Thank god, because I would have died of embarrassment if I had to face him again.

[u/uranium236 → u/Equivalent-Lie5822]

I’m picturing cartoon eyebrow waggles