Ketamine: Current applications in anesthesia, pain, and critical care

Madhuri S Kurdi, Kaushic A Theerth, Radhika S Deva, Madhuri S Kurdi, Kaushic A Theerth, Radhika S Deva

Abstract

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.

Keywords: Anesthesia; clinical applications; critical care; drug; ketamine; pain; palliative care; pediatrics; perioperative analgesia.

Conflict of interest statement

Conflict of Interest: None declared.

References

    1. Reves JG, Glass PS, Lubarsky DA, McEvoy MD, Ruiz RM. Intravenous anaesthetics. In: Miller RD, editor. Miller's Anaesthesia. 7th ed. USA: Churchill Livingstone; 2010. pp. 719–71.
    1. White PF, Elig MR. Intravenous anaesthetics. In: Barash PG, editor. Clinical Anaesthesia. 6th ed. China: Lippincott Williams and Wilkins; 2013. pp. 478–500.
    1. Stoelting RK, Hillier SC. Nonbarbiturate intravenous anaesthetic drugs. In: Stoelting RK, Hillier SC, editors. Pharmacology and Physiology in Anaesthetic Practice. 4th ed. Philadelphia: Lippincott Williams and Wilkin; 2006. pp. 155–78.
    1. Advisory Council on the Misuse of Drugs. Ketamine: A review of use and harm, 2013. Report. [Last accessed on 2014 Jul 08]. Available from: .
    1. Persson J. Wherefore ketamine? Curr Opin Anaesthesiol. 2010;23:455–60.
    1. Sleigh J, Harvey M, Voss L, Denny B. Ketamine-more mechanisms of action than just NMDA blockade. Trends Anaesth Crit Care. [In press]
    1. Hirota K, Lambert DG. Ketamine: New uses for an old drug? Br J Anaesth. 2011;107:123–6.
    1. Green SM. Modern anesthesiologists receive limited training with ketamine – Implications for emergency medicine. Acad Emerg Med. 2000;7:839–41.
    1. Goel S, Agrawal A. Ketamine in status asthmaticus: A review. Indian J Crit Care. 2013;1793:154–61.
    1. Dundee JW, Wyant GM. Intravenous Anasethesia. New York: Churchill Livingstone; 1988. Ketamine; pp. 135–59.
    1. Kolawole IK. Ketamine hydrochloride: A useful but frequently misused drug. Niger J Surg Res. 2001;3:118–25.
    1. Annetta MG, Iemma D, Garisto C, Tafani C, Proietti R. Ketamine: New indications for an old drug. Curr Drug Targets. 2005;6:789–94.
    1. Yoon SH. Concerns of the anesthesiologist: Anesthetic induction in severe sepsis or septic shock patients. Korean J Anesthesiol. 2012;63:3–10.
    1. Morris C, Perris A, Klein J, Mahoney P. Anaesthesia in haemodynamically compromised emergency patients: Does ketamine represent the best choice of induction agent? Anaesthesia. 2009;64:532–9.
    1. Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, et al. Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: A multicentre randomised controlled trial. Lancet. 2009;374:293–300.
    1. Sih K, Campbell SG, Tallon JM, Magee K, Zed PJ. Ketamine in adult emergency medicine: Controversies and recent advances. Ann Pharmacother. 2011;45:1525–34.
    1. Tavakollian AR, Allahyary E. The comparison of the effect of three anesthetic induction regimens on the arterial oxygen saturation in children with tetralogy of fallot undergoing cardiac surgery. Iran Red Crescent Med J. 2011;13:702–6.
    1. Goyal R, Singh S, Bangi A, Singh SK. Case series: Dexmedetomidine and ketamine for anesthesia in patients with uncorrected congenital cyanotic heart disease presenting for non-cardiac surgery. J Anaesthesiol Clin Pharmacol. 2013;29:543–6.
    1. Sungur Ulke Z, Kartal U, Orhan Sungur M, Camci E, Tugrul M. Comparison of sevoflurane and ketamine for anesthetic induction in children with congenital heart disease. Paediatr Anaesth. 2008;18:715–21.
    1. Gündüz M, Sakalli S, Güneş Y, Kesiktaş E, Ozcengiz D, Işik G. Comparison of effects of ketamine, ketamine-dexmedetomidine and ketamine-midazolam on dressing changes of burn patients. J Anaesthesiol Clin Pharmacol. 2011;27:220–4.
    1. O’Hara D, Ganeshalingam K, Gerrish H, Richardson P. A 2 year experience of nurse led conscious sedation in paediatric burns. Burns. 2014;40:48–53.
    1. Owens VF, Palmieri TL, Comroe CM, Conroy JM, Scavone JA, Greenhalgh DG. Ketamine: A safe and effective agent for painful procedures in the pediatric burn patient. J Burn Care Res. 2006;27:211–6.
    1. Samad MA, Islam MS, Ahmed M, Maruf AA. Evaluation of ketofol (ketamine-propofol combination) as total intravenous anaesthetic for burn dressing in adult patient. J Armed Forces Med Coll Bangladesh. 2012;8:20–4.
    1. Zhang MY, Wang G, Lin LF, Dong K, Bing XY, Chiang JS. Ketamine improves survival in severe burn injury in rats via the expression of heat shock protein. Colombian J Anesthesiol. 2013;70:82–7.
    1. Andrew R, Rushton A, Sneyd JR. Clinical pharmacology and anaesthetic techniques. In: Healy TE, editor. Wylie and Churchill Davidson's A Practice of Anaesthesia. 7th ed. Ch 35. London: Arnold Publishers; 2003. pp. 565–82.
    1. US Defence Health Board. Pre Hospital Use of Ketamine in Battlefield Analgesia in Tactical Combat Casualty Care Pain Guidelines. 2012 Mar
    1. Sibley A, Mackenzie M, Bawden J, Anstett D, Villa-Roel C, Rowe BH. A prospective review of the use of ketamine to facilitate endotracheal intubation in the Helicopter Emergency Medical Services (HEMS) setting. Emerg Med J. 2011;28:521–5.
    1. Ashkenazi I, Isakovich B, Kluger Y, Alfici R, Kessel B, Better OS. Prehospital management of earthquake casualties buried under rubble. Prehosp Disaster Med. 2005;20:122–33.
    1. Wason R, Jain N, Gupta P, Gogia AR. Randomized double-blind comparison of prophylactic ketamine, clonidine and tramadol for the control of shivering under neuraxial anaesthesia. Indian J Anaesth. 2012;56:370–5.
    1. Ozkan F, Kaya Z, Suren M. The effect of intravenous ketamine in prevention of hypotension during spinal anaesthesia in patients with benign prostatic hyperplasia. Nobel Medicus. 2011;7:82–8.
    1. Tsai PS, Hsu YW, Lin CS, Ko YP, Huang CJ. Ketamine but not propofol provides additional effects on attenuating sevoflurane-induced emergence agitation in midazolam premedicated pediatric patients. Paediatr Anaesth. 2008;18:1114–5.
    1. Riz KS, Samir EM. Use of ketofol to control emergence agitation in children undergoing adenotonsillectomy. Egypt J Anaesth. 2014;30:13–9.
    1. Mossetti V, Vicchio N, Ivani G. Local anesthetis and adjuvants in pediatric regional anesthesia. Curr Drug Targets. 2012;13:952–60.
    1. Xu Z, Zhang J, Shen H, Zheng J. Assessment of pulse oximeter perfusion index in pediatric caudal block under basal ketamine anesthesia. Scientific World Journal 2013. 2013:183493.
    1. Khanna P, Arora NK, Sunder RA. Adjuvants for intravenous regional anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26:287–91.
    1. Kumar A, Sharma D, Datta B. Addition of ketamine or dexmedetomidine to lignocaine in intravenous regional anesthesia: A randomized controlled study. J Anaesthesiol Clin Pharmacol. 2012;28:501–4.
    1. Kulkarni KR, Kadam AI, Namazi IJ. Efficacy of stellate ganglion block with an adjuvant ketamine for peripheral vascular disease of the upper limbs. Indian J Anaesth. 2010;54:546–51.
    1. Kamal MM, Hussein NS. Prevention of postspinal shivering by using ketamine plus midazolam in comparison with nefopam. Egypt J Anaesth. 2011;27:1–5.
    1. Gangopadhyaya S, Gupta K, Acharjee S, Nayak SK, Dawn S, Piplai G. Ketamine, tramadol and pethidine in prophylaxis of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26:59–63.
    1. Norouzi M, Doroodian MR, Salajegheh S. Optimum dose of ketamine for prevention of postanesthetic shivering; a randomized double-blind placebo-controlled clinical trial. Acta Anaesthesiol Belg. 2011;62:33–6.
    1. Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010;26:465–9.
    1. Tabbert K, Virginia A. Low dose intraoperative ketamine for prevention of post-operative shivering: A systemic review protocol. JBI Database Syst Rev Implement Rep. 2013;11:38–47.
    1. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57:449–61.
    1. Andolfatto G, Willman E, Joo D, Miller P, Wong WB, Koehn M, et al. Intranasal ketamine for analgesia in the emergency department: A prospective observational series. Acad Emerg Med. 2013;20:1050–4.
    1. Buck ML. Options for intranasal procedural sedation and analgesia in children. Paediatric Pharmacotherapy. 2013. [Last date accessed on 2014 Jul 07]. p. 19. Available at: .
    1. Gyanesh P, Haldar R, Srivastava D, Agrawal PM, Tiwari AK, Singh PK. Comparison between intranasal dexmedetomidine and intranasal ketamine as premedication for procedural sedation in children undergoing MRI: A double-blind, randomized, placebo-controlled trial. J Anesth. 2014;28:12–8.
    1. Khutia SK, Mandal MC, Das S, Basu SR. Intravenous infusion of ketamine-propofol can be an alternative to intravenous infusion of fentanyl-propofol for deep sedation and analgesia in paediatric patients undergoing emergency short surgical procedures. Indian J Anaesth. 2012;56:145–50.
    1. Khajavi M, Emami A, Etezadi F, Safari S, Sharifi A, Shariat Moharari R. Conscious sedation and analgesia in colonoscopy: Ketamine/propofol combination has superior patient satisfaction versus fentanyl/propofol. Anesth Pain Med. 2013;3:208–13.
    1. Atashkhoyi S, Negargar S, Hatami-Marandi P. Effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia during diagnostic gynaecological laparoscopy. Eur J Obstet Gynecol Reprod Biol. 2013;170:247–50.
    1. Hamimy W, Abdelaal A. The application of a new regimen for short term sedation in ICU (ketofol) – Case series. Egypt J Anaesth. 2012;28:179–82.
    1. Bar Joseph G, Guilburd Y, Guilburd J. Ketamine effectively prevents intracranial pressure elevation during endotracheal suctioning and other distressing interventions in patients with severe traumatic brain injury. Crit Care Med. 2009;37:3490–3.
    1. Bar-Joseph G, Guilburd Y, Tamir A, Guilburd JN. Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension. J Neurosurg Pediatr. 2009;4:40–6.
    1. Smischney NJ, Beach ML, Loftus RW, Dodds TM, Koff MD. Ketamine/propofol admixture (ketofol) is associated with improved hemodynamics as an induction agent: A randomized, controlled trial. J Trauma Acute Care Surg. 2012;73:94–101.
    1. Goyal R, Singh M, Sharma J. Comparison of ketamine with fentanyl as co-induction in propofol anesthesia for short surgical procedures. Int J Crit Illn Inj Sci. 2012;2:17–20.
    1. Erdogen MA, Begec Z, Aydogan MS, Ozgul U. Comparison of effects of propofol and ketamine mixture (ketofol) on laryngeal mask airway insertion conditions and haemodynamics in elderly patients: A randomized prospective double blind trial. J Anaesth. 2013;27:12–7.
    1. Singh H, Kundra S, Singh RM, Grewal A, Kaul TK, Sood D. Preemptive analgesia with ketamine for laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2013;29:478–84.
    1. Truta E, Vartic M, Cristea NA. Clinical study regarding preemptive analgesic effect of ketamine and remifentanyl in laparoscopic cholecystectomy. Farmacia. 2011;59:239–45.
    1. Hala S, Ghaffar-Abdel, Salem MA. Safety and analgesic efficacy of pre-emptive intranasal ketamine versus intranasal fentanyl in patients undergoing endoscopic nasal surgery. J Am Sci. 2012;8:430–36. Available at: .
    1. Clarke H, Woodhouse LJ, Kennedy D, Stratford P, Katz J. Strategies aimed at preventing chronic post. surgical pain: Comprehensive perioperative pain management after total joint replacement surgery. Physiother Can. 2011;63:289–304.
    1. Berti M, Baciarello M, Troglio R, Fanelli G. Clinical uses of low-dose ketamine in patients undergoing surgery. Curr Drug Targets. 2009;10:707–15.
    1. Javid MJ, Hajijafari M, Hajipour A, Makarem J, Khazaeipour Z. Evaluation of a low dose ketamine in post tonsillectomy pain relief: A randomized trial comparing intravenous and subcutaneous ketamine in pediatrics. Anesth Pain Med. 2012;2:85–9.
    1. Hosseini Jahromi SA, Hosseini Valami SM, Hatamian S. Comparison between effect of lidocaine, morphine and ketamine spray on post-tonsillectomy pain in children. Anesth Pain Med. 2012;2:17–21.
    1. Ducharme J. San Francisco, California: 2011. Oct 15-18, [Last accessed on 2014 Jul 08]. No pain, big gain; effective pain management program and abstracts of the American College of Emergency Physicians 2011 Scientific Assembly. Available from: .
    1. Hocking G, Cousins MJ. Ketamine in chronic pain management: An evidence-based review. Anesth Analg. 2003;97:1730–9.
    1. Garg R, Joshi S, Mishra S, Bhatnagar S. Evidence based practice of chronic pain. Indian J Palliat Care. 2012;18:155–61.
    1. Shanthanna H, Huilgol M, Manivackam VK. Early and effective use of ketamine for treatment of phantom limb pain. Indian J Anaesth. 2010;54:157–9.
    1. Huge V, Lauchart M, Magerl W, Schelling G, Beyer A, Thieme D, et al. Effects of low-dose intranasal (S)-ketamine in patients with neuropathic pain. Eur J Pain. 2010;14:387–94.
    1. Bell RF. Ketamine for chronic non-cancer pain. Pain. 2009;141:210–4.
    1. Blonk MI, Koder BG, van den Bemt PM, Huygen FJ. Use of oral ketamine in chronic pain management: A review. Eur J Pain. 2010;14:466–72.
    1. Niesters M, Martini C, Dahan A. Ketamine for chronic pain: Risks and benefits. Br J Clin Pharmacol. 2014;77:357–67.
    1. Hurley D. Two approaches to ketamine move forward for complex regional pain. Neurol Today. 2006;6:17–9.
    1. Rasmussen J, Malave A, Soto-Gomez N, Romero R, Eckwarn M. Ketamine and dexmedetomidine coma in CRPS. Neurology. 2013;80:02–11. Meeting abstracts.
    1. Schwartzman RJ, Alexander GM, Grothusen JR. The use of ketamine in complex regional pain syndrome: Possible mechanisms. Expert Rev Neurother. 2011;11:719–34.
    1. Benítez-Rosario MA, Salinas-Martín A, González-Guillermo T, Feria M. A strategy for conversion from subcutaneous to oral ketamine in cancer pain patients: Effect of a 1:1 ratio. J Pain Symptom Manage. 2011;41:1098–105.
    1. Visser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother. 2006;60:341–8.
    1. Winstock AR, Mitcheson L. New recreational drugs and the primary care approach to patients who use them. BMJ. 2012;344:e288.
    1. Chaudhary WA, Kennet J. Ketamine as an adjuvant to opioids for cancer pain management. Anaesth Pain Intensive care. 2012;16:174–8.
    1. Bell RF, Eccleston C, Kalso EA. Ketamine as an adjuvant to opioids for cancer pain. Cochrane Database Syst Rev. 2012;11:CD003351.
    1. Hudetz JA, Patterson KM, Iqbal Z, Gandhi SD, Byrne AJ, Hudetz AG, et al. Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2009;23:651–7.
    1. Penney R. Use of dexmedetomidine and ketamine infusions during scoliosis repair surgery with somatosensory and motor-evoked potential monitoring: A case report. AANA J. 2010;78:446–50.
    1. Saricaoglu F, Dal D, Salman AE, Doral MN, Kilinç K, Aypar U. Ketamine sedation during spinal anesthesia for arthroscopic knee surgery reduced the ischemia-reperfusion injury markers. Anesth Analg. 2005;101:904–9.
    1. Kranaster L, Kammerer-Ciernioch J, Hoyer C, Sartorius A. Clinically favourable effects of ketamine as an anaesthetic for electroconvulsive therapy: A retrospective study. Eur Arch Psychiatry Clin Neurosci. 2011;261:575–82.
    1. McDaniel WW, Sahota AK, Vyas BV, Laguerta N, Hategan L, Oswald J. Ketamine appears associated with better word recall than etomidate after a course of 6 electroconvulsive therapies. J ECT. 2006;22:103–6.
    1. Erdogan Kayhan G, Yucel A, Colak YZ, Ozgul U, Yologlu S, Karlıdag R, et al. Ketofol (mixture of ketamine and propofol) administration in electroconvulsive therapy. Anaesth Intensive Care. 2012;40:305–10.
    1. Firouzian A, Tabassomi F. Is ketamine-propofol mixture (ketofol) an appropriate alternative induction agent for electroconvulsive therapy? Saudi J Anaesth. 2013;7:476–7.
    1. Yalcin S, Aydoğan H, Selek S, Kucuk A, Yuce HH, Karababa F, et al. Ketofol in electroconvulsive therapy anesthesia: Two stones for one bird. J Anesth. 2012;26:562–7.
    1. Canbay O, Celebi N, Sahin A, Celiker V, Ozgen S, Aypar U. Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth. 2008;100:490–3.
    1. Rudra A, Ray S, Chatterjee S, Ahmed A, Ghosh S. Gargling with ketamine attenuates the postoperative sore throat. Indian J Anaesth. 2009;53:40–3.
    1. Abdallah CG, Fasula M, Kelmendi B, Sanacora G, Ostroff R. Rapid antidepressant effect of ketamine in the electroconvulsive therapy setting. J ECT. 2012;28:157–61.
    1. Ketamine. WHO Expert Committee on Drug Dependence 35th Meeting, Hammamet, Tunisia. 2012 Jun 4-8; Critical Review Report.
    1. Bajwa SJ, Takrouri MS. Innovations, improvisations, challenges and constraints: The untold story of anaesthesia in developing nations. Anaesth Essays Res. 2014;8:1–2.

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