17 Jan 12
Ketamine: new uses for an old drug?
By K Hirota and D Lambert
Br. J. Anaesth. (2011) 107 (2): 123-126.
In 1996, we published an editorial ‘Ketamine, mechanism(s) of action and unusual clinical uses’ in the British Journal of Anaesthesia. In that editorial, we described the pharmacology of ketamine including bronchodilator, anti-shock, and neuroprotective actions along with some unusual clinical applications. The editorial has been cited more than 130 times in total with around 10 citations every year, which implies that ketamine is still of interest to a wide audience. However, as ketamine anaesthesia is associated with cardiovascular hyperdynamics and disturbing emergence reactions, this agent is often avoided, despite the ease with which these adverse reactions can be prevented by pre-administration, co-administration of sedatives, or both such as benzodiazepines, propofol, dexmedetomidine, or droperidol.
In the past 15 yr, ketamine has been reported to possess several new clinically beneficial properties such as potentiation of opioid analgesia, prevention of opioid-induced acute tolerance and spinal ischaemia, anti-inflammatory actions, preventive effects on recall and awareness during general anaesthesia, and anti-tumour actions. In this ‘update’ editorial, we have focused on these potential clinical advantages of ketamine.