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Ketamine

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First Aid Perioperative Ultrasound

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Abstract

Ketamine is a nearly complete anesthetic especially its S-enantiomer which is useful for sedation, pre medication, induction and maintenance of anesthesia as well as post operative analgesia. It works mainly through NMDA receptor antagonism and is also a partial agonist at mu opioid receptor. It can be administered through multiple routes—intravenous, intramuscular, subcutaneous, intra-nasal or oral with varying bio-availability as it is metabolized mainly by hepatic enzymes. Ketamine by virtue of its stimulation of the sympathetic nervous system causes bronchodilation and is useful in patients with septic shock, hypovolemia and with pulmonary disease (like status asthmaticus). Ketamine is also useful as an adjunct for post-operative pain control as a part of ERAS protocol as even subanesthetic doses provide analgesic benefit especially for multiple surgical procedures and in patients that are opioid dependent for chronic pain where it can act as a potent analgesic.

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References

  1. Sinner B, Graf BM. Ketamine. Handb Exp Pharmacol. 2008;182:313–33.

    Article  CAS  Google Scholar 

  2. Morris PJ, Moaddel R, Zanos P, Moore CE, Gould T, Zarate CA, et al. Synthesis and N-methyl-d-aspartate (NMDA) receptor activity of ketamine metabolites. Org Lett. 2017;19(17):4572–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mion G, Villevieille T. Ketamine pharmacology: an update (pharmacodynamics and molecular aspects, recent findings). CNS Neurosci Ther. 2013;19(6):370–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Clements JA, Nimmo WS, Grant IS. Bioavailability, pharmacokinetics, and analgesic activity of ketamine in humans. J Pharm Sci. 1982;71(5):539–42.

    Article  CAS  PubMed  Google Scholar 

  5. White PF, Schüttler J, Shafer A, Stanski DR, Horai Y, Trevor AJ. Comparative pharmacology of the ketamine isomers. Studies in volunteers. Br J Anaesth. 1985;57(2):197–203.

    Article  CAS  PubMed  Google Scholar 

  6. Pelissier T, Laurido C, Kramer V, Hernández A, Paeile C. Antinociceptive interactions of ketamine with morphine or methadone in mononeuropathic rats. Eur J Pharmacol. 2003;477(1):23–8.

    Article  CAS  PubMed  Google Scholar 

  7. Eide PK. Wind-up and the NMDA receptor complex from a clinical perspective. Eur J Pain. 2000;4(1):5–15.

    Article  CAS  PubMed  Google Scholar 

  8. Shimoyama N, Shimoyama M, Inturrisi CE, Elliott KJ. Ketamine attenuates and reverses morphine tolerance in rodents. Anesthesiology. 1996;85(6):1357–66.

    Article  CAS  PubMed  Google Scholar 

  9. Lilius T, Kangas E, Niemi M, Rauhala P, Kalso E. Ketamine and norketamine attenuate oxycodone tolerance markedly less than that of morphine: from behaviour to drug availability. Br J Anaesth. 2018;120(4):818–26.

    Article  CAS  PubMed  Google Scholar 

  10. Sleigh J, Harvey M, Voss L, Denny B. Ketamine—more mechanisms of action than just NMDA blockade. Trends Anaesth Crit Care. 2014;4(2):76–81.

    Article  Google Scholar 

  11. Zhang JC, Li SX, Hashimoto K. R (−)-ketamine shows greater potency and longer lasting antidepressant effects than S (+)-ketamine. Pharmacol Biochem Behav. 2014;116:137–41.

    Article  CAS  PubMed  Google Scholar 

  12. Choi M, Lee SH, Park MH, Kim YS, Son H. Ketamine induces brain-derived neurotrophic factor expression via phosphorylation of histone deacetylase 5 in rats. Biochem Biophys Res Commun. 2017;489(4):420–5.

    Article  CAS  PubMed  Google Scholar 

  13. Duman RS. The dazzling promise of ketamine. Cerebrum. 2018;2018:cer-04-18.

    PubMed  PubMed Central  Google Scholar 

  14. Robson MJ, Elliott M, Seminerio MJ, Matsumoto RR. Evaluation of sigma (σ) receptors in the antidepressant-like effects of ketamine in vitro and in vivo. Eur Neuropsychopharmacol. 2012;22(4):308–17.

    Article  CAS  PubMed  Google Scholar 

  15. Kurdi MS, Theerth KA, Deva RS. Ketamine: current applications in anesthesia, pain, and critical care. Anesth Essays Res. 2014;8(3):283–90.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zanos P, Moaddel R, Morris PJ, Riggs LM, Highland JN, Georgiou P, et al. Ketamine and ketamine metabolite pharmacology: insights into therapeutic mechanisms. Pharmacol Rev. 2018;70(3):621–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Anghelescu DL, Tesney JM. Neuropathic pain in pediatric oncology: a clinical decision algorithm. Paediatr Drugs. 2019;21(2):59–70.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113(3):639–46.

    Article  CAS  PubMed  Google Scholar 

  19. Elia N, Tramèr MR. Ketamine and postoperative pain—a quantitative systematic review of randomised trials. Pain. 2005;113(1–2):61–70.

    Article  CAS  PubMed  Google Scholar 

  20. Riddell JM, Trummel JM, Onakpoya IJ. Low-dose ketamine in painful orthopaedic surgery: a systematic review and meta-analysis. Br J Anaesth. 2019;123(3):325–34.

    Article  CAS  PubMed  Google Scholar 

  21. Khalil A, Ganesh S, Hughes C, Tevar AD, Hasche JJ, Esper S, et al. Evaluation of the enhanced recovery after surgery protocol in living liver donors. Clin Transpl. 2018;32(8):e13342.

    Article  Google Scholar 

  22. Helander EM, Webb MP, Bias M, Whang EE, Kaye AD, Urman RD. A comparison of multimodal analgesic approaches in institutional enhanced recovery after surgery protocols for colorectal surgery: pharmacological agents. J Laparoendosc Adv Surg Tech A. 2017;27(9):903–8.

    Article  PubMed  Google Scholar 

  23. Martin LW, Sarosiek BM, Harrison MA, Hedrick T, Isbell JM, Krupnick AS, et al. Implementing a thoracic enhanced recovery program: lessons learned in the first year. Ann Thorac Surg. 2018;105(6):1597–604.

    Article  PubMed  Google Scholar 

  24. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57(5):449–61.

    Article  PubMed  Google Scholar 

  25. Morgan MM, Perina DG, Acquisto NM, Fallat ME, Gallagher JM, Brown KM, et al. Ketamine use in prehospital and hospital treatment of the acute trauma patient: a joint position statement. Prehosp Emerg Care. 2021;25(4):588–92.

    Article  CAS  PubMed  Google Scholar 

  26. Bowles ED, Gold ME. Rethinking the paradigm: evaluation of ketamine as a neurosurgical anesthetic. AANA J. 2012;80(6):445–52.

    PubMed  Google Scholar 

  27. Zeiler FA, Teitelbaum J, West M, Gillman LM. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care. 2014;21(1):163–73.

    Article  CAS  PubMed  Google Scholar 

  28. White PF, Way WL, Trevor AJ. Ketamine—its pharmacology and therapeutic uses. Anesthesiology. 1982;56(2):119–36.

    Article  CAS  PubMed  Google Scholar 

  29. Brinck EC, Tiippana E, Heesen M, Bell RF, Straube S, Moore RA, et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018;12(12):Cd012033.

    PubMed  Google Scholar 

  30. Grant IS, Nimmo WS, Clements JA. Pharmacokinetics and analgesic effects of i.m. and oral ketamine. Br J Anaesth. 1981;53(8):805–10.

    Article  CAS  PubMed  Google Scholar 

  31. Brown K, Tucker C. Ketamine for acute pain management and sedation. Crit Care Nurse. 2020;40(5):e26–32.

    Article  PubMed  Google Scholar 

  32. Cengiz P, Gokcinar D, Karabeyoglu I, Topcu H, Cicek GS, Gogus N. Intraoperative low-dose ketamine infusion reduces acute postoperative pain following total knee replacement surgery: a prospective, randomized double-blind placebo-controlled trial. J Coll Physicians Surg Pak. 2014;24(5):299–303.

    PubMed  Google Scholar 

  33. Bowers KJ, McAllister KB, Ray M, Heitz C. Ketamine as an adjunct to opioids for acute pain in the emergency department: a randomized controlled trial. Acad Emerg Med. 2017;24(6):676–85.

    Article  PubMed  Google Scholar 

  34. Pruskowski KA, Harbourt K, Pajoumand M, Chui SJ, Reynolds HN. Impact of ketamine use on adjunctive analgesic and sedative medications in critically ill trauma patients. Pharmacotherapy. 2017;37(12):1537–44.

    Article  CAS  PubMed  Google Scholar 

  35. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Ketamine: a review of clinical pharmacokinetics and pharmacodynamics in anesthesia and pain therapy. Clin Pharmacokinet. 2016;55(9):1059–77.

    Article  CAS  PubMed  Google Scholar 

  36. Davison SN. Clinical pharmacology considerations in pain management in patients with advanced kidney failure. Clin J Am Soc Nephrol. 2019;14(6):917–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Cohen SP, Bhatia A, Buvanendran A, Schwenk ES, Wasan AD, Hurley RW, et al. Consensus guidelines on the use of intravenous ketamine infusions for chronic pain from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, and the American Society of Anesthesiologists. Reg Anesth Pain Med. 2018;43(5):521–46.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Katalinic N, Lai R, Somogyi A, Mitchell PB, Glue P, Loo CK. Ketamine as a new treatment for depression: a review of its efficacy and adverse effects. Aust N Z J Psychiatry. 2013;47(8):710–27.

    Article  PubMed  Google Scholar 

  39. Perumal DK, Adhimoolam M, Selvaraj N, Lazarus SP, Mohammed MAR. Midazolam premedication for ketamine-induced emergence phenomenon: a prospective observational study. J Res Pharm Pract. 2015;4(2):89–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Sener S, Eken C, Schultz CH, Serinken M, Ozsarac M. Ketamine with and without midazolam for emergency department sedation in adults: a randomized controlled trial. Ann Emerg Med. 2011;57(2):109–14.e2.

    Article  PubMed  Google Scholar 

  41. Amr MAM, Shams T, Al-Wadani H. Does haloperidol prophylaxis reduce ketamine-induced emergence delirium in children? Sultan Qaboos Univ Med J. 2013;13(2):256–62.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Jansen KL, Darracot-Cankovic R. The nonmedical use of ketamine, part two: a review of problem use and dependence. J Psychoactive Drugs. 2001;33(2):151–8.

    Article  CAS  PubMed  Google Scholar 

  43. Morgan CJ, Curran HV. Ketamine use: a review. Addiction. 2012;107(1):27–38.

    Article  PubMed  Google Scholar 

  44. Wolff K, Winstock AR. Ketamine. CNS Drugs. 2006;20(3):199–218.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA

    Sukhman Shergill & Nalini Vadivelu

  2. Department of Anesthesiology, Yale University, New Haven, CT, USA

    Nalini Vadivelu

Authors
  1. Sukhman Shergill
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  2. Nalini Vadivelu
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Correspondence to Nalini Vadivelu .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, CT, USA

    Jinlei Li

  2. Shanghai Jiaotong University, Shanghai Sixth People’s Hospital, Shanghai, China

    Wei Jiang

  3. Department of Anesthesiology, Yale University, New Haven, CT, USA

    Nalini Vadivelu

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Shergill, S., Vadivelu, N. (2023). Ketamine. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_13

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  • DOI: https://doi.org/10.1007/978-3-031-21291-8_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21290-1

  • Online ISBN: 978-3-031-21291-8

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