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Ketamine hydrochloride, commonly known as ketamine, is a medication approved by the United States Food and Drug Administration (FDA) for use as a general anesthetic either on its own or in combination with other medications. The medication is highly effective for brief medical procedures that do not necessitate skeletal muscle relaxation and can be utilized as a pre-anesthetic for the induction of general anesthesia when combined with other general anesthetic agents. Furthermore, ketamine is FDA-approved for enhancing the effects of low-potency substances such as nitrous oxide. In addition to its anesthetic applications, ketamine proves invaluable in pain management, addressing treatment-resistant depression, managing suicidal ideation, and treating refractory status epilepticus, with specific indications awaiting FDA approval. The dosage determines the application and resulting effects of the drug, leading to variations in the prescribing protocol. This versatility renders ketamine valuable in both anesthesia and pain management. Ongoing research explores the potential applications of ketamine in psychiatry across all isomeric forms. At elevated doses, ketamine operates primarily as a sedative rather than an analgesic agent. This activity reviews ketamine's indications, mechanism of action, pharmacokinetics, adverse drug reactions, monitoring strategies, drug-drug interactions, and clinical toxicology for healthcare professionals to facilitate the enhancement of clinical best practice guidelines. Objectives: Identify appropriate indications for ketamine use, recognizing its role in general anesthesia, pain management, and potential applications in psychiatry. Screen patients thoroughly, assessing their medical history and contraindications to determine suitability for ketamine administration. Assess patients' responses to ketamine, adapting dosages and treatment plans based on individual needs and clinical outcomes. Collaborate with interdisciplinary teams, sharing expertise on ketamine's diverse applications and contributing to comprehensive patient care plans. Access free multiple choice questions on this topic.

Ketamine is potentially fatal in alcohol-intoxicated patients. It has been used recreationally as a drug of abuse. The street name for ketamine is "K" or "Special K." Illicit use of ketamine includes snorting or inhalation, and it is ingestable in food or drinks. The recreational use of ketamine can lead to toxicity.[49] Ketamine overdose induces varying dose-dependent symptoms, notably altering consciousness and manifesting as sedation, impaired mental status, mydriasis, and hemodynamic compromise. Accidental ingestion up to 10 times higher than the standard induction dose of ketamine has been reported. Overdose of ketamine did not result in systemic effects such as hemodynamic or central nervous system perturbations, except for prolonged awakening.[50] No antidote for ketamine is recognized. Treatment primarily involves supportive care and maintaining the airway, breathing, and circulation. Gastrointestinal decontamination with activated charcoal may be considered, while medications such as benzodiazepines, alpha-2 agonists, and anticholinergics assist in symptom management. Hydration with crystalloids can aid in managing hyperthermia and dehydration. Observation periods and continuous monitoring of post-symptom resolution are vital components of treatment. Ketamine misuse in recreational settings, with multiple substances, is a significant health concern. A study has revealed that ketamine, when combined with other drugs, is a significant contributor to overdoses and fatalities. Specifically, ketamine was found to be involved in 79% of overdose cases and 89.1% of deaths related to co-ingestants. This suggests a strong correlation between ketamine use and adverse outcomes when combined with other substances.[51]

Ketamine's primary use is by anesthesiologists, certified registered nurse anesthetists, dentists, emergency physicians, pain specialists, psychiatrists, and paramedics; these disciplines need to function as an interprofessional team to optimize the drug's effectiveness while minimizing the potential for adverse events. All clinicians who administer ketamine should understand the indications and contraindications. Nurses and pharmacists can play a crucial role during ordering and administration, guarding against improper dosing and checking for adverse events and drug interactions. [52] Resuscitative equipment is imperative if intubation is required. Before discharge, the clinical team must record the patient's vitals. Important discharge education includes informing patients not to drive, use heavy machinery, or perform potentially hazardous activities for 24 hours after the administration of ketamine. Critical care supervision is necessary for patients under mechanical ventilation. An interprofessional team approach is necessary to improve patient outcomes related to ketamine and minimize adverse drug reactions.