Role and Advantageousness of Ketamine in Obese and Non-Obese Patients: Peri-Interventional Considerations

Abstract

Obese and morbidly obese patients are a growing group of individuals that generates medical, social and economic problems worldwide. They undergo various interventions that require anesthesia and/or analgesia. Despite their healthy look, these individuals are graded at high ASA physical status, mainly because of their impaired respiratory and cardiovascular conditions, and the metabolic changes their body undergoes. Opioids are the default drugs for perioperative analgesia. Nevertheless, their use has reached a frightening epidemic-like condition worldwide. Multimodal analgesia regimens have been recommended as a perioperative standard of care, particularly for the obese. These regimens employ combinations of opioids and non-opioid compounds that augment the formers' analgesic potencies, thus providing superior pain relief at rest, movement, or on effort, while reducing opioid consumption and their concerned adverse effects. The most important perioperative IV adjuvant currently employed is ketamine that sees resurgence among physicians from diverse medical specialties. After summarizing obese patients' perioperative drawbacks, this review will illustrate ketamine’s neuropharmacology, and will describe its therapeutic usefulness as an analgesic adjuvant. Since data regarding the use of the drug in obese patients is scarce, brief examplifications of its benefits in non-obese cohorts will be portrayed as well.