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Ketamine tolerance and sedation for surgical proceedure

T

thickskin

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Jul 19, 2009
Messages
259
Hi,

I'm wondering how ketamine tolerance could effect sedation for a surgical procedure. I have had this proceedure before and I know from reading the notes at the time that it was sedation with an NMDA receptor antagonist (I know it wasn't ketamine) and either a benzo or opiate (can't remember but maybe not relevant to my question).

I used mxe and ketamine reasonably frequently for 3 months at this time last year and used about 2.5g of it about 2 months ago. Last week I got some ketamine (quality was very high) and found I had a pretty big tolerance that I wasn't expecting (had taken ketamine since november last year). I needed to use 200mg to k hole the first time I did it and still it wasn't exactly overwhelming. The other 600mg I had I just split over a few days with drinks but each time I had it I noticed it seemed pretty weak for me.

So I want to know if I should be worried about getting sedated at the end of the week. Is it possible that my tolerance will mean the sedation might not be complete or will they just increase the dose if I am still awake after the countdown from 10?

Thanks for any advice (also not 100% sure this is the right place to post this)
 
thickskin said:
Hi,

I'm wondering how ketamine tolerance could effect sedation for a surgical procedure. I have had this proceedure before and I know from reading the notes at the time that it was sedation with an NMDA receptor antagonist (I know it wasn't ketamine) and either a benzo or opiate (can't remember but maybe not relevant to my question).

I used mxe and ketamine reasonably frequently for 3 months at this time last year and used about 2.5g of it about 2 months ago. Last week I got some ketamine (quality was very high) and found I had a pretty big tolerance that I wasn't expecting (had taken ketamine since november last year). I needed to use 200mg to k hole the first time I did it and still it wasn't exactly overwhelming. The other 600mg I had I just split over a few days with drinks but each time I had it I noticed it seemed pretty weak for me.

So I want to know if I should be worried about getting sedated at the end of the week. Is it possible that my tolerance will mean the sedation might not be complete or will they just increase the dose if I am still awake after the countdown from 10?

Thanks for any advice (also not 100% sure this is the right place to post this)
Click to expand...


You should have a brief interview with the anesthesiologist prior to the surgery. Tell them about your drug use. If you already had your interview and didn't tell them you are an idiot.
 
I don't think ketamine is used for sedation/anaesthesia for surgery in most cases and I don't know how much if any cross tolerance exists between it and other anaesthetics. However you should definitely tell your anesthesiologist before the procedure, it's his job to know these things and adjust the drugs and doses to make the procedure as safe and as painless as possible.
 
In general, it shouldn't be something you have to worry about, since they'll make sure you're properly sedated or anesthetized before they begin the procedure. Keep in mind that if you are given ketamine, it will be through IV, which will provide a different effect than you are used to. It's doubtful that your tolerance to ketamine is high enough to surpass whatever the maximum dose they're willing to give is.

Also keep in mind that it's entirely possible for the ketamine you used this past week could have been of a lesser potency. Unless you're obtaining the vials and precipitating the crystals yourself, you can never be sure how pure it is. In the hospital, you can be sure of its potency and purity.

I've been given ketamine for as anesthesia for a few procedures (mostly orthodontia I think) and also as a treatment for pain post surgery, sometimes when I had been using K and MXE rather frequently. I never experienced any less than ideal effects.

Contrary to what the 2nd poster said, I don't think it's necessary for you to advertise that you've been abusing ketamine to your doctor, surgeon or anesthesiologist, unless you are explicitly asked about your drug usage patterns. Often times, the fact that you're using these drugs will be practically irrelevant to the success or danger of the procedure, but it can cause extreme complications with both your healthcare provider and your treatment. I let slip to my surgeon that I was a smoker a few days before my procedure, without even being explicitly asked, and he subsequently refused to perform the operation. I had to find a different surgeon. It doesn't seem like your abusing large amounts of ketamine daily, but if you tell them that you're using it, that's the conclusion that they'll jump to. There's no gray area in healthcare when it comes to drug use. Either you're an addict or you're not.
 
Ondine said:
I let slip to my surgeon that I was a smoker a few days before my procedure, without even being explicitly asked, and he subsequently refused to perform the operation. I had to find a different surgeon.
Click to expand...
Why? What was his reason?
 
Mandark said:
Why? What was his reason?
Click to expand...

It was orthopedic surgery. Apparently some recent studies are showing reduced rates of bone healing among smokers. He didn't explain himself that clearly, but I'm supposing that he didn't want to operate on someone with a reduced healing rate. If I was a senior citizen or had some condition that had the same effect, I don't think he would have discriminated, but since I chose to be a smoker... whatever.

I ended up getting the surgery and healing up perfectly sooner than most patients. After looking into the studies myself, I have to say that they didn't seem all that conclusive..
 
sekio said:
ketamine is only used for emergency anethesia as far as I know, not for inpatient operations.
Click to expand...

Also supposedly used in pediatric patients and cats (true story, my cat got a shot of ketamine before having her elbow repaired.. looked a bit high for a few minutes).
 
NMDA antagonists are not use as aneasthetics under normal conditions...

Everytime they have put me under it's always propofol+sevoflurane and sometimes fentanyl.
 
My girlfriend was recently put under with ketamine in order to have her wisdom teeth removed. She had a moderate ketamine tolerance at the time but it was negligible when compared with the dose used for the procedure. She was only given ketamine for the surgery because of bad reactions to benzos for surgery she'd had in the past.
 
If they used an NMDA-antagonist last time it would have to be ketamine, since no other NMDA-antagonists are used for anesthesia. Unless you live in some really obscure place I don't know about.

Ketamine use is not common outside of emergency situations (ambulance, ER, warzones/third world) but is making a comeback. Ketamine should really be the number one anesthetic in people with severe hypotension (trauma/sepsis).
 
I was given a ketamine drip along with a morphine pump for about a day after I had calcaneus (heel) reconstruction surgery. I forget the mg/time, but it did work wonderfully. I wasn't aware of them giving ketamine for pain control post-op, but it seems like a fairly new thing.
 
If really getting ketamine and not an IM user don't worry, your usage isn't high and you haven't used in a while despite tolerance lowering slow. An IM/IV of proper ket will have you gone mate don't worry yourself.
 
All I can say is, you k holed off of 200mg?
I don't think you have to worry, you're tolerance may be high relatively, but even when I have no tolerance the lowest I can k hole off of is usually 300mg if its good.
Maybe 200 if I have this one batch I got this one time haha, again that's with no tolerance
 
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