Ketamine: Current applications in anesthesia, pain, and critical care.

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Abstract

Ketamine was introduced commercially in 1970 with the manufacturer's description as a "rapidly acting, nonbarbiturate general anesthetic" and a suggestion that it would be useful for short procedures. With the help of its old unique pharmacological properties and newly found beneficial clinical properties, ketamine has survived the strong winds of time, and it currently has a wide variety of clinical applications. It's newly found neuroprotective, antiinflammatory and antitumor effects, and the finding of the usefulness of low dose ketamine regimens have helped to widen the clinical application profile of ketamine. The present article attempts to review the current useful applications of ketamine in anesthesia, pain and critical care. It is based on scientific evidence gathered from textbooks, journals, and electronic databases.

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Most cited references 110

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Ketamine for chronic pain: risks and benefits.

Marieke Niesters, Christian Martini, Albert Dahan (2014)

The anaesthetic ketamine is used to treat various chronic pain syndromes, especially those that have a neuropathic component. Low dose ketamine produces strong analgesia in neuropathic pain states, presumably by inhibition of the N-methyl-D-aspartate receptor although other mechanisms are possibly involved, including enhancement of descending inhibition and anti-inflammatory effects at central sites. Current data on short term infusions indicate that ketamine produces potent analgesia during administration only, while three studies on the effect of prolonged infusion (4-14 days) show long-term analgesic effects up to 3 months following infusion. The side effects of ketamine noted in clinical studies include psychedelic symptoms (hallucinations, memory defects, panic attacks), nausea/vomiting, somnolence, cardiovascular stimulation and, in a minority of patients, hepatoxicity. The recreational use of ketamine is increasing and comes with a variety of additional risks ranging from bladder and renal complications to persistent psychotypical behaviour and memory defects. Blind extrapolation of these risks to clinical patients is difficult because of the variable, high and recurrent exposure to the drug in ketamine abusers and the high frequency of abuse of other illicit substances in this population. In clinical settings, ketamine is well tolerated, especially when benzodiazepines are used to tame the psychotropic side effects. Irrespective, close monitoring of patients receiving ketamine is mandatory, particularly aimed at CNS, haemodynamic, renal and hepatic symptoms as well as abuse. Further research is required to assess whether the benefits outweigh the risks and costs. Until definite proof is obtained ketamine administration should be restricted to patients with therapy-resistant severe neuropathic pain.

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Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update.

Baruch Krauss, Mark G Roback, Ian R. Kennedy … (2011)

We update an evidence-based clinical practice guideline for the administration of the dissociative agent ketamine for emergency department procedural sedation and analgesia. Substantial new research warrants revision of the widely disseminated 2004 guideline, particularly with respect to contraindications, age recommendations, potential neurotoxicity, and the role of coadministered anticholinergics and benzodiazepines. We critically discuss indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, recovery issues, and future research questions for ketamine dissociative sedation. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass.

Judith A Hudetz, Paul S Pagel, Anthony Hudetz … (2009)

To determine if ketamine attenuates postoperative delirium concomitant with an anti-inflammatory effect in patients undergoing cardiac surgery using cardiopulmonary bypass. A prospective randomized study. A Veterans Affairs medical center. Cardiac surgical patients. Patients at least 55 years of age randomly received placebo (0.9% saline, n = 29) or an intravenous bolus of ketamine (0.5 mg/kg intravenously, n = 29) during anesthetic induction in the presence of fentanyl and etomidate. Delirium was assessed by using the Intensive Care Delirium Screening Checklist before and after surgery. Serum C-reactive protein concentrations were determined before and 1 day after surgery. The incidence of postoperative delirium was lower (p = 0.01, Fisher exact test) in patients receiving ketamine (3%) compared with placebo (31%). Postoperative C-reactive protein concentration was also lower (p < 0.05) in the ketamine-treated patients compared with the placebo-treated patients. The odds of developing postoperative delirium were greater for patients receiving placebo compared with ketamine treatment (odds ratio = 12.6; 95% confidence interval, 1.5-107.5; logistic regression). After cardiac surgery using cardiopulmonary bypass, ketamine attenuates postoperative delirium concomitant with an anti-inflammatory effect.

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Author and article information

Journal

Journal ID (iso-abbrev): Anesth Essays Res

Title: Anesthesia, essays and researches

Publisher: Medknow

ISSN: 0259-1162

ISSN (Print): 2229-7685

Publication date (Electronic): April 18 2015

Volume: 8

Issue: 3

Affiliations

[1 ] Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India.

Article

Publisher Item ID: AER-8-283

DOI: 10.4103/0259-1162.143110

PMC ID: 4258981

PubMed ID: 25886322

SO-VID: 18876bd8-5419-461c-8283-0c00a8cbe4d7

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Keywords: Anesthesia,clinical applications,critical care,drug,ketamine,pain,palliative care,pediatrics,perioperative analgesia

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Keywords: Anesthesia, clinical applications, critical care, drug, ketamine, pain, palliative care, pediatrics, perioperative analgesia

Ketamine: Current applications in anesthesia, pain, and critical care.

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Electrospinning for biomedical applications

Most cited references 110

Ketamine for chronic pain: risks and benefits.

Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update.

Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass.

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