Ketamine (“Ketalar”): A Safer Anaesthetic for ECT

Abstract

Ketamine (‘Ketalar’), a recently introduced phencyclidine derivative, is a dissociative anaesthetic agent with a number of unique and useful properties. Its most important advantages are the relatively good preservation of the swallowing and cough reflexes, and its rapid absorption following intramuscular injection. In addition, it has little depressant effect on respiration, while blood pressure is usually raised (Morgan et al., 1971; Bovill et al., 1971). It also has the effect of increasing muscular tone, thus preventing airway obstruction by the tongue.

Rapid Antidepressant Effect of Ketamine in the Electroconvulsive Therapy Setting

“…Therefore, it is logical to question whether co-administration of ketamine could expedite the antidepressant response of ECT. Interestingly, ketamine has been used in ECT anesthesia for decades 18, 19 , with preliminary evidence suggesting that ketamine anesthesia in ECT may improve seizure duration relative to other anesthetic agents that are commonly used, and to minimize side effects, particularly cognitive impairment 20, 21 . However, there is no evidence that the direct antidepressant effects of the drug were considered as a potential benefit to the use of drug in these early studies.…”

Effects of S-Ketamine as an Anesthetic Adjuvant to Propofol on Treatment Response to Electroconvulsive Therapy in Treatment-Resistant Depression

“…S(+) ketamine has been found to be a potent and effective anesthetic with less psychotomimetic adverse effects than racemic ketamine. 24,25 Its effect in hemodynamic variables and liability to increase intracranial pressure are considered less desirable, and for routine ECT, methohexital and propofol are preferred. 16,17 Propofol is one of the most popular anesthetic agents used in ECT anesthesia, 18 because of its rapid recovery and minor hemodynamic effects.…”

Ketamin als Anästhetikum bei der Elektrokrampftherapie

“…Ketamin wurde bereits 1972 in einer ersten Studie als Anästhetikum bei der EKT eingesetzt sowie bezüglich Sicherheit und Verträglichkeit als mit Thiopental vergleichbar beschrieben [23]. Damals wurde eine mittlere i.v.-Ketamin-RazematDosis von 2,2 mg/kgKG verwendet.…”

“…Pharmakodynamisch und klinisch entspricht die Wirkung von 2 mg/kgKG KetaminRazemat ungefähr 1 mg/kgKG S-Ketamin [24]. Dementsprechend sind die eingesetzten 2,2 mg/kgKG der Ketamin-Razemat-Studie [23] mit der von den Autoren des vorliegenden Beitrags verwendeten Dosis von ca. 1 mg/kgKG S-Ketamin vergleichbar.…”