Ketamine use in current clinical practice

Abstract

After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

The ketamine crisis: Does South Africa have a plan B?

“…Since its first clinical use in 1970, ketamine has continued to remain a critical component of the medical arsenal of anaesthesiologists and clinicians treating both acute and chronic pain, in particular finding a growing use in the management of adult and paediatric burns. [7] Over the past two decades, several studies have investigated the additional antidepressant and anti-inflammatory effects of ketamine. [7][8][9] The appeal of ketamine in the clinical setting is its versatility as a result of its unique ability to induce three clinical outcomes, i.e.…”

“…[7] Over the past two decades, several studies have investigated the additional antidepressant and anti-inflammatory effects of ketamine. [7][8][9] The appeal of ketamine in the clinical setting is its versatility as a result of its unique ability to induce three clinical outcomes, i.e. narcosis, analgesia and amnesia.…”

“…There is currently no other medicine used in clinical practice that can provide these three effects simultaneously. [7] Apart from its rapid onset of action, it does not induce hypotension and there is minimal risk of airway loss because the pharyngeal and laryngeal reflexes are only slightly impaired. It also rarely induces bronchospasm, which makes it particularly useful in asthmatic patients as well as in children.…”

Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain

“…Ketamine [2‐( o ‐chlorphenyl)‐2‐methylamino cyclohexanone] is a phencyclidine derivative with unique analgesic, amnestic, and dissociative properties . It acts primarily as a competitive antagonist at the N ‐methyl‐ d ‐aspartate (NMDA) receptor within the limbic system to modulate autonomic responses to stimuli . As a treatment option for pain, ketamine has numerous advantages over opioids including a stable hemodynamic profile and lack of respiratory depression .…”

“…It acts primarily as a competitive antagonist at the N ‐methyl‐ d ‐aspartate (NMDA) receptor within the limbic system to modulate autonomic responses to stimuli . As a treatment option for pain, ketamine has numerous advantages over opioids including a stable hemodynamic profile and lack of respiratory depression . Recent studies have demonstrated ketamine's effectiveness for pain control in patients who present to the ED with acute pain syndromes when infused in a subdissociative dose by itself or in conjunction with NSAIDs .…”