From the Guidelines
Ketamine is a phencyclidine derivative that has been available since 1970, possessing both analgesic and sedative properties, and is used for endoscopic sedation, anesthesia, and pain management. Ketamine causes functional dissociation between the limbic and cortical systems, selectively depressing the cortex and thalamus while stimulating parts of the limbic system, producing a trance-like cataleptic state that impairs sensory recognition of painful stimuli and memory 1. The use of ketamine for endoscopic sedation has been studied predominantly in the pediatric setting, with a combination of ketamine and midazolam showing less frequent inadequate sedation and fewer complications compared to other sedation regimens 1. Some key points about ketamine include:
- Rapid onset of action (1 min) and short duration of effect (10–15 min) after intravenous administration 1
- Easy to administer, with no depression of airway or cardiovascular reflexes, unlike benzodiazepine/narcotic regimens 1
- Potential side effects include emergence reactions, such as floating sensations, vivid dreams, hallucinations, and delirium, which can be minimized with the use of midazolam in combination with ketamine 1
- Contraindications include patients with ischemic heart disease, cerebrovascular disease, or hypertension, due to ketamine's dose-dependent increase in heart rate, blood pressure, and cardiac output 1. The standard dose range for ketamine is 0.75–2.0 mg/kg per dose, and it should be used with caution and careful monitoring due to its psychoactive properties and cardiovascular effects.
From the FDA Drug Label
Ketamine hydrochloride injection, USP for intravenous or intramuscular use, contains ketamine, a nonbarbiturate general anesthetic Ketamine hydrochloride, USP is a white crystalline powder and has a molecular formula of C13H16ClNO•HCl and a molecular weight of 274.19. The chemical name for ketamine hydrochloride is dl-2-(o-Chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride.
Ketamine (Ketamine hydrochloride) is a nonbarbiturate general anesthetic. It is a white crystalline powder with a molecular formula of C13H16ClNO•HCl and a molecular weight of 274.19. The chemical name for ketamine hydrochloride is dl-2-(o-Chlorophenyl)-2-(methylamino) cyclohexanone hydrochloride 2.
From the Research
Definition and Mechanism of Ketamine
- Ketamine is a dissociative anesthetic that works by blocking N-methyl-D-aspartate (NMDA) receptors 3, 4, 5, 6, 7
- It was developed in 1962 as a less hallucinogenic and shorter-acting agent than phencyclidine 3
Clinical Uses of Ketamine
- Ketamine has been used for analgesia in adults and children, particularly in cases of opioid resistance, neuropathic pain, and central sensitization 4, 5, 7
- It has anti-hyperalgesic, anti-allodynic, and tolerance-protective effects, making it useful for managing chronic pain and preventing opioid-induced hyperalgesia 4, 5
- Ketamine also has anti-depressive actions and has been used in the acute management of depression 3, 6
Administration and Side Effects
- Ketamine can be administered through various routes, including intravenous, intramuscular, subcutaneous, oral, rectal, topical, intranasal, sublingual, epidural, and caudal routes 7
- Common side effects of ketamine include hallucinations, raised intracranial and blood pressures, seizures, and dysphoric effects 3
- Long-term exposure to ketamine, particularly in recreational users, may lead to serious side effects 7