Ketamine's reputation as a date rape and party drug might scare your anesthesia providers off from using it. And that's a shame. Besides inducing anesthesia, ketamine also has significant analgesic properties. When administered at low doses before or during surgery, ketamine provides great intra- and post-op pain control — without hallucinations. Plus, it's a non-opioid that reduces morphine consumption and decreases pain scores. And unlike general anesthetics, ketamine won't cause a patient to stop breathing by suppressing the respiratory reflex.

Yes, there's a lot to like about ketamine. First, though, you must help your anesthesia providers and surgeons get past ketamine's Special K's reputation. These talking points might help.

1No hallucinations. Reports of hallucinations associated with ketamine's use go back to the 1960s. But here's the thing to remember: Hallucinations are based on dose. At a low dose, hallucinations are non-existent. I typically use a bolus of 0.5mg/kg. and follow with a 0.2-0.3 mg/kg/hr. infusion for cases longer than an hour. You don't have to worry about putting your patients in a dangerous spot at those doses.

2An anesthetic and an analgesic. Ketamine is a key part of our multimodal analgesia, which also includes acetaminophen, celecoxib, gabapentin, IV magnesium, lidocaine and ketorolac. These patients report pain levels of 0 on a scale of 1 to 10 and require little to no post-op opioids — including those who are opioid-dependent or opioid-tolerant.

3It's a non-opioid. As providers, we have a responsibility to do what we can to curb the opioids crisis. Frighteningly, from 1999 to 2014, more than 165,000 persons died from overdose related to opioid pain medication in the United States, according to the Centers for Disease Control and Prevention. Ketamine is not an opioid, and frankly, I think it controls pain better and has fewer side effects.

4Can replace propofol. Ketamine is good for all patients, but especially useful to induce anesthesia in patients who are not candidates to receive propofol or other induction agents like methohexital or etomidate. It's also not subject to shortage and therefore readily available.

5Sedates aggressive patients. Ketamine can be very useful in pre-op. It comes in handy when I need to get an IV line in patients who can be physically challenging, such as children, the mentally retarded or those who are aggressive. We once had a mentally retarded, physically challenging teenage patient who was giving us a tough time getting in a line. Sedating him using 5 mg/kg of ketamine as an intra-muscular injection (what we refer to as a ketamine dart) made it much easier.

6Helps with post-operative pain. I also use ketamine to help with post-op pain. All of our patients undergo relatively short procedures, so a single bolus may be sufficient in the majority of cases. When a case runs longer, we use that 0.2-0.3 mg/kg/hr. infusion after the bolus.

7Opens the airways. Ketamine is a good bronchodilator. It opens up the airways, which makes it a good choice in patients with respiratory issues, like asthma and chronic obstructive pulmonary disease (COPD).

8Works fast. Ketamine is short-acting. Its onset times are less than 30 seconds, it lasts 40 minutes and has a half-life of 10-15 minutes. That means patients can be discharged quickly, as long as they are pain free.

An old drug learns new tricks

Ketamine's anesthetic mechanism of action and its analgesic properties might deserve a second look. All I can tell you is that ketamine does well in all my patients. I only hesitate to use it when a patient has an allergy to it, obviously, or when the patients cardiovascular history precludes its use.

Ketamine's use in the OR is on the rise. More and more providers are relying on it instead of opioids. Now you know 8 good reasons why. OSM