930 Peri-Operative Considerations for Adult Populations Undergoing General Anaesthesia While Undergoing Ketamine Treatment

Summary

Adults receiving therapeutic ketamine for conditions like depression or chronic pain may have altered responses to anesthesia during unrelated surgeries. A review of evidence from 2015 to 2025 found that these patients can develop tolerance to anesthetic induction agents and show variable cardiovascular effects, ranging from high blood pressure and rapid heart rate to blunted responses. Interactions with other psychiatric medications add to unpredictability during surgery. After surgery, some patients experience transient dissociation or perceptual disturbances that can be hard to distinguish from their baseline psychiatric symptoms. The findings underscore the need for individualized anesthetic dosing, careful hemodynamic monitoring, and better communication among clinicians, as standardized guidelines are lacking.

Study at a glance

Abstract

Abstract Aim Ketamine is increasingly used for treatment-resistant depression, bipolar disorder, PTSD, chronic pain, and other psychiatric conditions[8,9]. As more adults receive serial ketamine infusions or intranasal esketamine, perioperative considerations with ongoing NMDA-receptor modulation. However, perioperative guidance remains limited, creating uncertainty around anesthetic dosing, hemodynamic stability, and postoperative neuropsychiatric responses^2^. This review synthesizes current evidence on perioperative considerations for adults receiving therapeutic ketamine and identifies strategies for safe anesthetic management. Method A scoping and systematic retrospective review was conducted following PRISMA20 guidelines, examining publications from 2015–2025 across PubMed, Embase, and Cochrane. Search terms included ketamine, esketamine, maintenance therapy, anesthesia, perioperative management, and hemodynamics. Eligible studies included clinical trials, observational studies, pharmacologic analyses, and case reports involving adults on therapeutic ketamine undergoing unrelated procedures. Exclusion criteria were recreational ketamine use, procedural sedation, and pediatric populations. Extracted data addressed anesthetic requirements, cardiovascular responses, drug interactions, postoperative emergence, and clinical recommendations. Results Adults receiving therapeutic ketamine demonstrated altered anesthetic requirements, including possible tolerance to induction agents and variable interactions with additional dissociatives. Cardiovascular effects ranged from hypertension and tachycardia associated with sympathomimetic activation to blunted responses suggesting receptor desensitization [1,2,4,5]. Psychotropic polypharmacy further contributed to intraoperative variability[2,4–7,9]. Postoperatively, transient dissociation, perceptual disturbances, and difficulty distinguishing emergence reactions from baseline psychiatric symptoms were reported [8]. Conclusions Evidence supports individualized perioperative planning for adults receiving therapeutic ketamine. Adjusted anesthetic dosing, targeted hemodynamic monitoring, and clear interdisciplinary communication are essential. The absence of standardized guidelines highlights the need for prospective research to inform perioperative best practices.

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