Ketamine Pharmacokinetics and Pharmacodynamics for Postpartum Depression and Pain After Cesarean Delivery

Peripartum Participants

Inclusion Criteria

• Cesarean delivery
• Adults 18 years and older
• Term delivery ≥ 37 weeks gestation anticipated at time of delivery
• ASA PS 2 or 3
• Able to provide informed consent
• One of the following must be met for inclusion: Not planning to breastfeed OR ketamine use indicated for pain management plan.

Exclusion Criteria

• Patient going under general anesthesia for cesarean delivery
• Allergy to study medication (ketamine)
• ASA PS 4 +
• Contraindications to neuraxial anesthesia
• Preterm delivery (\<37 weeks gestation)
• Anticipated fetal-neonatal complex care plan as indicated in the patient's chart
• Patient history of ketamine or PCP abuse
• Patient history of schizophrenia or psychosis
• Patient history of liver or renal insufficiency
• Patient history of uncontrolled hypertension, chest pain, arrhythmia, head trauma, or intracranial hypertension, uncontrolled hyperthyroidism, or other contraindications to ketamine
• Participating in another pain or depression intervention trial
• Undergoing hormonal or gender affirming therapies
• Pre-eclampsia with severe features
• Hemodynamic instability
• Inability to participate in study procedures for any reason
• Contraindicated medications use: oral antihypertensive medications (exclusion: hypertensive disorders of pregnancy), intravenous magnesium (exclusion: pre-eclampsia with severe features), ketamine/phencyclidine/psilocybins/any other psychedelics (exclusion: ketamine or PCP abuse), lithium/valproate/carbamazepine/lamotrigine/haloperidol/chlorpromazine/fluphenazine/aripiprazole/clozapine/other typical or atypical antipsychotic medications (exclusion: schizophrenia or psychosis)

Control Participants

Inclusion Criteria

• Age 18 years and older
• Sex: Male or Female
• Able to provide informed consent
• ASA PS 1, 2, or 3

Exclusion Criteria

• Allergy to study medication (ketamine)
• ASA PS 4 +
• Inability to participate in study procedures for any reason
• Patient history of ketamine or PCP abuse
• Patient history of schizophrenia or psychosis
• Patient history of liver or renal insufficiency
• Patient history of uncontrolled hypertension, chest pain, arrhythmia, head trauma, intracranial hypertension, uncontrolled hyperthyroidism, or other contraindications to ketamine
• Participating in another pain or depression intervention trial
• Hemodynamic instability
• Pregnant or pregnant within the last 6 weeks
• Unwilling to provide urine sample for pregnancy testing (female controls)
• Undergoing hormonal or gender affirming therapies
• Contraindicated medications use: ketamine, phencyclidine, psilocybins, or other psychedelics (exclusion: ketamine or PCP abuse), lithium/valproate/carbamazepine/lamotrigine/haloperidol/chlorpromazine/fluphenazine/aripiprazole/clozapine, or other typical or atypical antipsychotic medications (exclusion: schizophrenia or psychosis)