AANA Issues Updated Practice Considerations for Ketamine Therapy for Psychiatric Disorders and Chronic Pain Management

ROSEMONT, Ill. (AANA)— The American Association of Nurse Anesthesiology (AANA) recently updated its practice considerations addressing ketamine therapy to cite the most current studies, as AANA continues to support a patient-centered, interdisciplinary approach to providing care and treatment to persons with psychiatric disorders or chronic pain. Included in these revised considerations is the use of esketamine nasal spray, an FDA-approved treatment for treatment-resistant depression (TRD) in adults, and depressive symptoms in patients with major depressive disorder (MDD).

Ketamine therapy has been shown to have antidepressive properties and is increasingly being used to treat psychiatric disorders, including major depressive disorder, bipolar disorder, treatment-resistant depression, and post-traumatic stress disorder.

Certified Registered Nurse Anesthetists (CRNAs), also known as nurse anesthesiologists or nurse anesthetists, have extensive training in the delivery of pain management medications such as ketamine and management of associated side effects or complications. The updated practice considerations feature a greatly expanded pharmacologic review section.

“CRNAs are highly trained in delivering professional, compassionate anesthesia and related care and have the expertise to safely administer all forms of ketamine, making their involvement a valuable solution. Their ability to provide anesthesia services autonomously in various healthcare settings can increase the availability of this therapy, especially in remote or underserved areas,“ said Tracy Young, MSNA, MBA, CRNA, and member of AANA’s Board of Directors. “These updated ketamine practice considerations are based on the most current literature identified through AANA’s evidence-based process and give CRNAs a comprehensive analysis of this unique area of practice”.

When administering ketamine for treatment of psychiatric disorders, CRNAs collaborate with psychiatric-mental health professionals whose practice includes diagnosing psychiatric disorders within their professional and state scope of practice. The practice considerations advise the importance of continued screening, monitoring, and follow-up of patients with psychiatric disorders or chronic pain throughout treatment and management.

With ketamine infusion clinics becoming more available, CRNAs or other qualified anesthesia providers should participate in the creation, review, and periodic updating of evidence-based policies and procedures at the clinics and evaluation of the availability of necessary routine and emergency monitors, supplies, and equipment.

“CRNAs’ education in pharmacology and holistic approach to patient care, including their strong focus on patient education and emotional support, can help reduce the stigma surrounding ketamine therapy and mental health treatments and improve patients’ acceptance,” Young said.

The CRNA’s role in ketamine infusion therapy may include, but is not limited to, reviewing healthcare records; obtaining a health history; conducting a pre-infusion assessment and evaluation; ordering and evaluating diagnostic tests; ordering or prescribing medications; initiating, maintaining, titrating, and discontinuing the infusion; monitoring the patient; and conducting post-infusion assessment and evaluation.