Dwayne Accardo, DNP, CRNA, FAANA
Investigative Techniques | Medicine and Health Sciences | Nursing
Opioids during surgery have been clinically proven to lengthen the time between intubation and post-op extubation. Increased time to extubation is associated with negative patient outcomes. This scoping review aims to evaluate the use of ketamine with opioid free analgesia (OFA) versus traditional opioid usage and its outcomes on extubation times.
From September 2021 to November 2021, we conducted a literature search using the University of Tennessee Health Science Center’s (UTHSC) online library. Through the PubMed, CINAHL, Medline, and Cochrane databases, we identified seventy-one articles that matched our criteria. Of those articles, we selected twenty-five to undergo rapid critical appraisal (RCA). We then chose ten articles that were critically appraised and were from peer-reviewed sources. Finally, we constructed an outcome synthesis table and level of evidence table to synthesize the results of those ten articles.
Ten articles were chosen for this scoping review. Nine articles show that the use of ketamine decreases the time to extubation, with five proving to be statistically significant. Four articles demonstrated a decrease in ICU length of stay in days with the ketamine-based anesthesia group. Five articles found a significant decrease in postoperative opioid consumption in the ketamine-based anesthesia group. The results demonstrate that there is evidence favoring the use of ketamine and opioid free anesthesia to decrease extubation times, decrease ICU lengths of stay, and decrease postoperative opioid consumption.
Implications for Nursing Practice
This scoping review has demonstrated that ketamine, when used as a perioperative adjunct for pain control, will reduce opioid usage and times to extubation. Implementation of routine ketamine administration should be considered in populations that may have prolonged intubation times.
Connor, Mary K. RN, BSN, SRNA; Browning, Dexter RN, BSN, SRNA; Clark, Ariel RN, BSN, SRNA; Gates, Erica B. RN, BSN, SRNA; McCaskill, Madison T. RN, BSN, SRNA; and Accardo, Dwayne L. DNP, CRNA, FAANA , "Impact of Opioid-Free Anesthesia Versus Opioid-Based Anesthesia on Time to Extubation: A Scoping Review" (2023). Doctor of Nursing Practice Projects. Paper 55. http://dx.doi.org/10.21007/con.dnp.2023.0055.