Evaluation of Clinical Factors Associated with Adverse Drug Events in Patients Receiving Sub-Anesthetic Ketamine Infusions

• Published in: Journal of pain research 2019-12, Vol.12, p.3413-3421
• Main Authors: Stoker, Alexander D, Rosenfeld, David M, Buras, Matthew R, Alvord, Jeremy M, Gorlin, Andrew W
• Format: Article
• Language: English
• Subjects: adverse; Anesthesia; Antidepressants; Central nervous system; Central nervous system agents; Central nervous system depressants; Chronic pain; Complications and side effects; depression; Depression (Mood disorder); Diplopia; Diseases; Drug dosages; drug-event; Drugs; Ketamine; Mental depression; Mental disorders; Narcotics; Nystagmus; Original Research; Pain; Patients; Regression analysis
• ISSN: 1178-7090; 1178-7090
• DOI: 10.2147/JPR.S217005

Sub-anesthetic ketamine is frequently used as an analgesic to reduce perioperative opioid consumption and has also been shown to have antidepressant effects. Side effects of ketamine include dizziness, diplopia, nystagmus, and psychomimetic effects. It is unclear what clinical factors may be associated with ketamine-related adverse drug events (ADEs). We performed a retrospective review of 95 patients who received sub-anesthetic ketamine infusions at our institution. Data examined associations between ketamine-related ADEs and various clinical characteristics including chronic pain, depression, or psychiatric disorder, patient physical characteristics, chronic opioid use, perioperative opioid use, dose and duration of ketamine infusions, pain scores, and perioperative medications such as serotonergic agents, central nervous system (CNS) depressants, and analgesics. Overall incidence of ketamine-related ADEs was 29.5% and the incidence of psychomimetic effects was 14.8%. We observed that patients with a history of depression have a lower incidence of ketamine-related ADEs compared to patients without a history of depression (10.3% vs 37.3%; value = 0.007). Patients with depression were found to have a statistically significant reduction in the incidence of ketamine-related ADEs. We found no statistically significant positive associations between ketamine-related ADEs and other clinical factors such as a history of chronic pain, psychiatric disease, patient physical characteristics, perioperative opioid use, dose of ketamine infusion, or co-administration of other CNS depressants.