Back in residency, I had learned about the wonderful uses of ketamine for pain control…especially in patients with morbid obesity coming in for gastric bypass procedures. Ketamine worked wonderfully in these patients to decrease the amount of narcotic that could have bad side effects such as respiratory depression.
Then, I got to thinking about CABGs and ketamine for decreasing heavy dose narcotics and aiding “fast-tracking” these cardiac patients. Lo and behold, I came across these articles that provided me with some information:
- Continuous S-(+)-ketamine administration during elective coronary artery bypass graft surgery attenuates pro-inflammatory cytokine response during and after cardiopulmonary bypass.
- S(+)-ketamine as an analgesic adjunct reduces opioid consumption after cardiac surgery.
So, instead of inducing with ketamine and midazolam, I think I’ll continue my same induction… however, work in ketamine during rewarming from CPB and provide no further narcotic. I’m wondering if ketamine’s cardiac depressant effects will hurt me during this time. After that thought, maybe it’s better that I consider ketamine for induction.