Is Marla in the room for the whole infusion?

Marla is in the room for induction and the dissociative peak, when patients need the most direct attention. For stable, low-acuity sessions she may step briefly into the adjacent charting area to document, with continuous monitoring on the screen and the door open. She is on-site and available throughout, oversees every infusion, and checks in regularly. We are honest about this rather than overselling continuous bedside presence.

What does she actually watch on the monitor?

Continuous heart rate, blood pressure cycled at regular intervals, oxygen saturation by pulse oximetry, and respiratory rate. She also assesses mental status and airway clinically. Ketamine typically causes a modest rise in blood pressure and heart rate; that is expected. Sustained hypertension, drops in oxygen saturation, irregular breathing, or unusual emergence behavior are what trigger a clinical intervention.

Can she change the dose during the infusion?

Yes. The infusion runs on a programmable pump that she can slow, pause, or adjust at any time based on blood pressure, dissociation depth, nausea, or patient comfort. If the experience is too intense, she can dial it back. If vitals drift, she titrates to bring them in line. This is a CRNA-led, anesthesia-grade workflow, not a fixed-rate drip.

What is she trained to handle if something goes wrong?

CRNAs are anesthesia-trained clinicians. Marla holds current ACLS certification and is trained in advanced airway management, IV access, and the use of emergency medications kept on-site. Serious adverse events in office-based ketamine are rare, but the response capability is the same as you would expect in a hospital procedural-sedation setting. That is the entire point of an anesthesia-led clinic.

Does a therapist sit with me during the infusion?

No. Marla runs the medical side of the session — the IV, the pump, the monitor, the documentation. Integration support, when patients want it, happens separately and is coordinated with outside therapists. We are clear about the difference between medical monitoring and psychotherapy, and we do not represent the infusion itself as a therapy session.

What Marla Actually Does During a Ketamine Infusion

Who Marla is, and why a CRNA is the right person at the controls

Marla Peterson is a Certified Registered Nurse Anesthetist. CRNAs are advanced-practice nurses who complete a graduate anesthesia program, pass a national board exam, and maintain clinical competence in airway management, hemodynamic monitoring, and the pharmacology of every drug used to sedate or anesthetize a patient. In hospitals, CRNAs deliver the majority of anesthetics in the United States. In an office-based ketamine clinic, the CRNA is the most clinically appropriate person to run the medication.

Ketamine is FDA-approved as an anesthetic; its use for depression, PTSD, anxiety, and chronic pain is off-label. That off-label framing matters for how the session is run. The dose used for psychiatric and pain indications is sub-anesthetic — far below what would put you under for surgery — but the drug is the same molecule, with the same pharmacology. At sub-anesthetic doses ketamine still raises blood pressure and heart rate modestly, can produce vivid dissociation, and in rare cases can cause respiratory irregularities or laryngospasm. Anesthesia training is what makes those rare events recoverable rather than catastrophic. A CRNA-led model is not a marketing choice — it is what the clinical standard calls for.

Before the infusion: pre-procedure check and consent confirmation

Before the IV is started, Marla reviews your chart and walks through a focused pre-procedure check. She confirms your fasting status, current medications, allergies, last blood pressure, and any changes since your consultation. She asks about sleep, hydration, recent illness, and how you are feeling that day — not as small talk, but because each of those affects how ketamine will land. She reconfirms consent and the plan for the session.

If you have never done this before, she walks you through what the first few minutes will feel like and how to signal her if you become uncomfortable. Preparing for the first infusion is its own topic, and Marla treats this part as clinical, not ceremonial. Once everything is confirmed, she places the IV herself, attaches the monitoring leads, and gets a baseline set of vitals on the pump and monitor before the medication ever starts to flow.

Starting the infusion: the first three to five minutes

The pump is programmed to your weight-based dose and infusion time. When Marla starts the run, she stays at the bedside through induction. The first few minutes are when the dissociative effects come on, when blood pressure typically nudges upward, and when patients are most likely to feel uncertain about what is happening. She watches the monitor and watches you. She talks if you want her to talk and stays quiet if you want quiet. What the experience actually feels like varies, but the early window is consistent enough that her presence at the start is the standard of care.

This is also when she confirms that the IV is running cleanly, that the pump rate matches the order, and that no early adverse reaction is developing. If anything looks off — sustained hypertension, a drop in oxygen saturation, an unusual emergence pattern — this is when she catches it.

Continuous monitoring: HR, BP, SpO2, ETCO2, mental status

Throughout the infusion, the monitor displays continuous heart rate, continuous oxygen saturation by pulse oximetry, and a non-invasive blood pressure cycled at regular intervals. For sessions that warrant it, capnography (end-tidal CO2) tracks the quality of your breathing in real time. Respiratory rate and rhythm are observed clinically and on the waveform.

The American Society of Anesthesiologists (ASA) Standards for Basic Anesthetic Monitoring (last amended 2020, originally 1986) require continuous evaluation of oxygenation, ventilation, circulation, and temperature during all anesthetics, with qualified anesthesia personnel present. The American Association of Nurse Anesthesiology (AANA) Practice Considerations: Office-Based Anesthesia (2020) carry the same expectation into the office setting, calling for continuous monitoring of oxygenation, ventilation, circulation, and level of consciousness during sedation, with the anesthesia provider in continuous attendance. The American Society of Ketamine Physicians, Psychotherapists & Practitioners (ASKP3) Clinical Practice Guidelines for Ketamine Infusion Therapy (2023) specifically recommend continuous pulse oximetry and intermittent blood pressure monitoring throughout IV ketamine sessions, with a qualified clinician immediately available and trained in ACLS and airway management.

That is the framework. In practice, what it looks like is Marla checking the monitor frequently, watching for trends rather than single readings, and adjusting the room — temperature, lighting, the angle of the recliner, an emesis basin if needed — to match what the data and the patient are telling her.

Titration: how Marla actually adjusts the dose mid-session

The infusion is not a fixed-rate drip. The pump is programmable and titratable, and Marla can change the rate, pause it, or stop it entirely at any point. Three things tend to drive a titration decision:

Blood pressure. Ketamine routinely raises systolic blood pressure by 10–30 mmHg in the early part of the infusion. That is expected and not a problem on its own. If a patient's BP climbs higher than the predetermined ceiling for their history, she slows the pump or pauses it until the number settles. In rare cases she has anti-hypertensive medication available on-site.
Dissociation depth. If the dissociation is more intense than the patient wants — overwhelming rather than therapeutic — she can dial the rate down so the experience becomes manageable without aborting the session. Patients with prior infusion experience sometimes ask for the opposite: a slightly deeper run. She adjusts as needed within the prescribed range.
Comfort and side effects. Nausea, anxiety on emergence, or persistent discomfort can be addressed with antiemetics, brief reorientation, or a pause in the infusion. Dissociation is part of how the medication works, but it should not feel like distress.

Every change is documented in real time — what was adjusted, why, and what the response looked like. That documentation is part of the medical record and part of how protocols evolve over multiple sessions.

When she steps out — and what continuous monitoring means

This is the part of the article we want to be especially honest about. For low-acuity, mid-session windows where a patient is stable and resting in the dissociative space, Marla may step briefly out of the room to chart in the adjacent charting area. The door stays open. The monitor display is visible from where she is sitting. The pump runs only at the rate she set, and she returns to the bedside well before emergence.

She is on-site and available throughout. She oversees every infusion. She checks in regularly, and the moment anything on the monitor changes, she is immediately back in the room. We do not describe this as continuous bedside presence, because it is not, and we would rather be transparent than oversell it. AANA standards permit brief departures from the immediate bedside during stable monitoring, provided the anesthesia provider remains in continuous attendance — which means on the premises, immediately available, and continuously monitoring the patient. That is how we operate. Our safety overview lays out the same standard.

What she watches for: airway, hypertension, emergence reactions

The clinical events Marla is trained to recognize and manage are uncommon at sub-anesthetic ketamine doses, but anesthesia training is built around the assumption that anything can happen and you have to be ready for it.

Airway. Ketamine generally preserves airway reflexes, which is part of why it is one of the safer agents for office sedation. But laryngospasm, secretions, or positional airway compromise can occur, and Marla is trained in advanced airway management with the appropriate equipment on-site.
Hypertension. Most ketamine-related blood pressure rises are self-limited. Sustained elevations above the patient's individual ceiling are managed with rate adjustment, pause, or anti-hypertensive medication.
Emergence reactions. Some patients have intense or distressing emergence experiences. Reorientation, a calmer environment, and in some cases a small dose of a benzodiazepine can resolve them. Marla makes that call in the moment.
Cardiac irregularities. Tachycardia is expected; new arrhythmia is not. The continuous monitor catches it; she responds to it.

None of this is meant to alarm — the published safety record for office-based IV ketamine in CRNA-led settings is very strong — but the reason it is strong is that the monitoring and clinician training take the rare events seriously.

Recovery and the handoff at discharge

As the infusion winds down, Marla returns to the bedside for the emergence period. Vitals are watched until they return to baseline, mental status is assessed, and she confirms that the patient is oriented, steady, and tolerating fluids before clearing them for discharge to a driver. She documents the full session: vitals trends, any titration events, side effects, response to treatment, and any observations relevant to future sessions.

If something noteworthy happened — a higher BP than expected, a particularly intense emergence, an effective adjustment — she flags it for the next session so the protocol can be tuned. That cumulative record is part of why repeat patients often have smoother sessions over time.

Why this level of detail matters

Most marketing for ketamine clinics says "supervised by a CRNA" and stops there. We think you deserve a real description of what supervision actually looks like, including the parts that are less convenient to describe — like the brief charting steps and the limits of what one clinician can do in a single room. The honest version is more reassuring than the oversold version, because it tells you that the safety standard is real and adhered to, not a slogan.

The clinical framework we operate inside is set by AANA, ASA, and ASKP3, and it is the same framework you would expect from any responsible office-based sedation practice. Marla runs the medical side of every session at Music City Ketamine. Integration support, when patients want it, is coordinated separately with outside therapists — we do not represent the infusion itself as a therapy session, and a therapist does not sit in the room. The medication is a medical procedure. The therapy, if you want it, happens around the medication.