The ketamine enigma

Revista Médica del Hospital General de México, 2016

The pharmacological effects of ketamine are being discovered constantly, and new mechanisms involving epi-genetics could account for some of its clinical responses. Nowadays, it is regarded as a pharmacological tool in translational research and has the potential to revolutionise the therapy of complex patient conditions such as pain and depression. Medical interest in exploring the drug's properties has grown, as is demonstrated by the increased investigation over the last five years, according to research sites such as Pubmed. These publications draw attention to the multifaceted roles of ketamine as an anaesthetic, analgesic (in multiple contexts, chronic, acute, refractory and breakthrough pain), antihyperalgesic, neuromodulator, bronchodilator and/or antidepressant. It is therefore important to review the pharmacological characteristics and their implications in current treatments.

Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2015

Journal of Clinical Medicine

Pain is the leading cause of medical consultations and occurs in 50–70% of emergency department visits. To date, several drugs have been used to manage pain. The clinical use of ketamine began in the 1960s and it immediately emerged as a manageable and safe drug for sedation and anesthesia. The analgesic properties of this drug were first reported shortly after its use; however, its psychomimetic effects have limited its use in emergency departments. Owing to the misuse and abuse of opioids in some countries worldwide, ketamine has become a versatile tool for sedation and analgesia. In this narrative review, ketamine’s role as an analgesic is discussed, with both known and new applications in various contexts (acute, chronic, and neuropathic pain), along with its strengths and weaknesses, especially in terms of psychomimetic, cardiovascular, and hepatic effects. Moreover, new scientific evidence has been reviewed on the use of additional drugs with ketamine, such as magnesium infusi...

Pharmacy Today, 2018

Anesthesiology, 2005

Anesthesia: Essays and Researches, 2014

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.

The Journal of emergency medicine, 2017

Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain. The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED. This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain. Patients received ketamine 0.3 mg/kg via intravenous piggyback over 15 min or placebo. Morphine 0.1 mg/kg intravenous push was administered with the study interventions. The primary outcome was the patient's pain score 15 min after initiation of the intervention. Secondary outcomes included adverse events, consumption of rescue analgesia, patient's length of stay, and patient satisfactio...