2025-12-01 – Weekly CRNA News : Ketamine and SSRIs: BIS monitoring impact

Last week in our CRNA community, discussions centered around practical challenges and educational opportunities. Members delved into the interaction between ketamine and SSRIs, sparking a conversation about how this affects BIS monitoring. There was a lively exchange on ultrasound presets and their role in speeding up regional anesthesia procedures. Additionally, the forum explored continuing education courses designed to enhance protocol compliance and the common pitfalls new CRNAs face with quality assurance. Finally, there was a shared interest in finding effective CE courses focused on opioid-sparing strategies during perioperative pain management.


This Week’s Hot Topics

Ketamine on SSRIs makes BIS chatty
This conversation explores the intriguing impact of combining ketamine with SSRIs and how it influences BIS monitoring, a topic of practical importance for CRNAs managing complex cases.
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Ultrasound presets that speed regional starts
Members shared their experiences with various ultrasound presets that can streamline regional anesthesia procedures, making this a valuable read for those looking to enhance efficiency.
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CE that tightens protocol compliance
A discussion on continuing education courses that specifically aim to improve protocol adherence, offering insights for CRNAs seeking to refine their practice.
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Where new CRNAs stumble on QA
This thread highlights common challenges new CRNAs encounter with quality assurance, providing tips and experiences to help navigate these early career hurdles.
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Looking for CE on opioid-sparing perioperative pain
An inquiry into effective CE courses that focus on opioid-sparing methods during perioperative care, a crucial area for improving patient outcomes.
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Thank you for staying engaged with our community. Your contributions and discussions continue to enrich our collective knowledge.

@ErinCRNA With SSRI patients, ketamine reliably bumps the BIS, so I take a 20–30s raw EEG baseline after induction and then follow the EMG bar and suppression ratio instead of the index; jaw relaxation plus a small propofol bump usually clears the noise. If the number stays high but SR is zero and vitals are steady, I don’t add more gas; in very anxious high-dose SSRI cases I swap ketamine for dexmedetomidine.

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I bump BIS smoothing to 15s and watch SEF95; ultrasound ‘nerve’ preset speeds blocks — if EMG spikes, jaw taping helps.

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And quick tip: I push ketamine only after a 45–60 s clean raw EEG with BIS SQI >90, then I ignore the number and watch suppression ratio plus artifact trend. If EMG stays busy, 0.2–[redacted]/kg dexmedetomidine smooths it better than jaw taping for me, @ErinCRNA — on days I’m on SedLine, PSI is steadier with SSRI+ketamine so I lean on SEF/BSR instead.

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