Anesthesiology and Intensive Care

Ketamine: The Past, Present, and Potential Future of an Anesthetic Drug ketamine, depression treatment, anesthesia, ketamine-assisted psychotherapy, PTSD, esketamine, NMDA receptors, chronic pain Ketamine is a powerful anesthetic drug that has been used in medical settings for decades. However, its effects on the brain have also led to its use as a recreational drug, leading to controversy surrounding its use. Despite its negative associations, recent research has shown promising potential for the drug in the treatment of mental health conditions such as depression and post-traumatic stress disorder (PTSD).

Perioperative Pain Management

American Society of Regional Anesthesia and Pain Medicine, American Academy of Pain Medicine, and American Society of Anesthesiologists For spinal cord injury pain, there is weak evidence supporting ketamine infusions (0.42 mg/kg per hour to 0.4 mg/kg ranging from 17 minutes to 5 hours for 7 consecutive days) for short-term improvements in pain.

Different clinical scenarios lend themselves to the use of certain induction agents when rapid sequence intubation (RSI) is needed. Head injury or stroke   —  In the patient with potentially elevated intracranial pressure (ICP) from head injury or stroke or other conditions, adequate cerebral perfusion pressure must be maintained to prevent secondary brain injury. This means avoiding elevations in ICP and maintaining adequate mean arterial pressure. For these reasons, etomidate or ketamine are used for induction of these patients. If the patient is hypertensive at the time of induction, etomidate is preferable, as it will not further elevate the blood pressure. In normotensive or hypotensive patients, either agent can be used. In the severely hypotensive patient, ketamine is preferable. Ketamine's analgesic effects minimize the adverse sympathetic stimulation of laryngoscopy, while etomidate lacks such effect. Pretreatment with a low do...

Conclusions of some studies that investigated e ffect of ketamine on bispectral index (BIS). Effect of ketamine on bispectral index during propofol--fentanyl anesthesia: a randomized controlled study.  Sengupta S ,  Ghosh S ,  Rudra A ,  Kumar P ,  Maitra G ,  Das T .                 Click to read more from source CONCLUSION : Thus, under stable propofol anesthesia, a bolus of  KETAMINE 0.5 MG/KG INCREASES BIS VALUES WHILE KETAMINE 0.2 MG/KG DOES NOT.                         Comparative effects of ketamine on Bispectral Index and spectral entropy of the electroencephalogram under sevoflurane anaesthesia   P.Hans, P.-Y. Dewandre ,  J. F. Brichant  and  V. Bonhomme Click to read more from source Conclusions.  Ketamine administered under sevoflurane anaesthesia causes a  signi...

    Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression.  Ketamine produces a unique cataleptic trance known as disassociative anesthesia.     Dissociative anesthesia is a unique anesthesia characterized by analgesia and amnesia with minimal effect on respiratory function. The patient does not appear to be anesthesized and can swallow and open eyes but does not process information.     Ketamine was first tested in humans at the Parke Davis Research Unit of Jackson Prison in Michigan. The first human received the drug on August 3, 1964. By 1970, it was approved as an anesthetic agent by the US FDA. Advantages and Precautions Ketamine induces significant increases in HR, mean arterial pressure, and plasma epinephrine levels. This sympathetic nervous system stimulation is centrally mediated.  It can be harmful in patients with stenotic heart le...