From the Guidelines
When teaching a patient about ketamine, it is essential to explain that it works by blocking NMDA receptors in the brain, which affects pain perception and mood regulation, and to inform them about the potential side effects, such as dissociative experiences, elevated blood pressure and heart rate, nausea, and dizziness, as reported in studies 1.
Key Points to Discuss with the Patient
- Ketamine is a medication used for anesthesia, pain management, and treatment of certain mental health conditions like depression.
- The medication can be administered intravenously, intramuscularly, orally, or as a nasal spray (esketamine/Spravato) depending on the purpose of treatment.
- For depression treatment, typical protocols involve multiple sessions over several weeks, while pain management dosing varies based on individual needs.
- Important side effects to discuss include:
- Dissociative experiences (feeling detached from reality)
- Elevated blood pressure and heart rate
- Nausea
- Dizziness
- These effects are usually temporary and resolve within hours after administration.
- Patients should be advised not to drive or operate machinery for at least 24 hours after receiving ketamine and to have someone accompany them to appointments.
- They should also disclose all medications they're taking, as ketamine can interact with certain drugs, particularly other central nervous system depressants.
- For those receiving ketamine for mental health conditions, emphasize that it's typically part of a comprehensive treatment plan that may include psychotherapy and other medications, as noted in studies 1.
Administration and Monitoring
- Ketamine has a rapid onset of action (1 minute) and short duration of action (15-30 minutes) 1.
- It is easy to administer and does not depress airway or cardiovascular reflexes, making it a safe option for sedation in various settings, including gastrointestinal endoscopy 1.
- Monitoring of the patient's vital signs and oxygen saturation is crucial during and after ketamine administration to promptly identify and manage any potential adverse effects.
From the FDA Drug Label
Due to the residual anesthetic effects and the potential for drowsiness, advise patients not to drive an automobile, operate hazardous machinery, or engage in hazardous activities within 24 hours of receiving ketamine hydrochloride. The patient should be advised not to drive an automobile, operate hazardous machinery, or engage in hazardous activities within 24 hours of receiving ketamine hydrochloride due to the potential for drowsiness and residual anesthetic effects 2.
- Key points to teach the patient:
- Do not drive a car
- Do not operate hazardous machinery
- Avoid hazardous activities
- Wait for at least 24 hours after receiving ketamine hydrochloride
From the Research
Patient Education on Ketamine
When teaching a patient about ketamine, several key points should be covered:
- Mechanism of Action: Ketamine functions primarily as an antagonist of the N-methyl-D-aspartate receptor, with no affinity for gamma-aminobutyric acid receptors in the central nervous system 3.
- Pharmacokinetics: Ketamine undergoes oxidative metabolism, mainly to norketamine by cytochrome P450 (CYP) 3A and CYP2B6 enzymes, and has poor oral bioavailability due to extensive first-pass metabolism 3.
- Therapeutic Uses: Ketamine is used for anesthesia, pain therapy, and treatment of depression, with potential applications in palliative care and mental health care 3, 4, 5.
- Administration: Ketamine can be administered through various routes, including sublingual, nasal, and intravenous, with nasal administration producing rapid maximum plasma ketamine concentrations and relatively high bioavailability 3.
- Side Effects: Patients should be aware of potential side effects, including psychotomimetic and cognitive adverse effects, which can be mitigated with the use of S-ketamine 3.
- Cardiovascular Effects: Ketamine can cause mild to moderate increases in blood pressure, heart rate, and cardiac output due to increased sympathetic activity, which may be a concern for patients with underlying cardiac disease 6, 7.
- Monitoring: Patients should be monitored for changes in vital signs, including blood pressure and heart rate, during and after ketamine administration 6, 7.