Ketamine Infusions: Role and Use in Ambulatory Surgery Centers

As many patients are refractory to traditional methods of treatment for chronic neuropathic pain and psychiatric illness, physicians and researchers looked to other avenues for alternative treatment possibilities. Ketamine, which has actually been around for over 50 years, is a dissociative anesthetic, used historically mostly for induction of anesthesia and functions via N-methyl-d-aspartate receptor complex inhibition. While the undesired dissociative effects have caused it to have limited, but necessary, utility as an induction agent, ketamine delivered at subanesthetic doses has shown to improve pain and depressive symptoms in patients suffering from chronic pain or depression refractory to standard treatment. Ketamine infusions are quickly becoming more popular among patients and providers as treatment alternatives for pain or depression that is not responding to the traditional method of treatment. Patients across the United States continue to be at risk of opioid abuse as the search for powerful non-opioid analgesia is still ongoing. Ketamine infusions delivered at subanesthetic doses may also be a possibility as treatment for patients suffering from opioid addiction. Currently, ketamine infusions are offered around the United States as an off-label treatment for chronic pain, post-traumatic stress disorder (PTSD), depression, and a variety of other psychiatric and neuropathic pain conditions. In this chapter, we discuss the role of ambulatory surgery centers in ketamine infusions and benefits for patients and providers.