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Acute Delirium After Ketamine Infusion for Chronic Pain

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Challenging Cases and Complication Management in Pain Medicine

Abstract

Unlike acute pain, chronic pain is hard to manage and is resistant to many interventions. The N-methyl-d-aspartate (NMDA) receptor is key in chronic pain, making it a prime target for treatment. Ketamine is the most commonly used NMDA antagonist used in the management of chronic pain. A short-term infusion of ketamine produces potent analgesia during administration. Some studies of prolonged infusion (4–14 days) show long-term analgesic effects up to 3 months. The common adverse effects of ketamine reported in clinical studies are nervous system symptoms (hallucinations, memory defects, panic attacks, somnolence), gastrointestinal symptoms (nausea/vomiting), cardiovascular stimulation, and, in a few cases, liver failure. In a clinical setting, ketamine is well tolerated, especially when benzodiazepines are used to prevent its psychotropic effects. In monitoring patients receiving ketamine, the focus is on central nervous system or hemodynamic changes during infusion, hepatic function, and the potential for abuse on repeated administration.

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Authors and Affiliations

  1. University of Chicago Hospitals, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Tariq Malik M.D.

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  1. Tariq Malik M.D.
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Correspondence to Tariq Malik M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, Illinois, USA

    Magdalena Anitescu

  2. Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA

    Honorio T. Benzon

  3. Division of Pain Medicine, Department of Anesthesiology, University of California San Diego School of Medicine, La Jolla, California, USA

    Mark S. Wallace

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Malik, T. (2018). Acute Delirium After Ketamine Infusion for Chronic Pain. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_6

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  • DOI: https://doi.org/10.1007/978-3-319-60072-7_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60070-3

  • Online ISBN: 978-3-319-60072-7

  • eBook Packages: MedicineMedicine (R0)

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