CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Reich, D. L.
Right arrow Articles by Silvay, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Reich, D. L.
Right arrow Articles by Silvay, G.

Canadian Journal of Anesthesia, Vol 36, 186-197, Copyright © 1989 by Canadian Anesthesiologists' Society

ARTICLES

Ketamine: an update on the first twenty-five years of clinical experience

DL Reich and G Silvay
Department of Anaesthesiology, Mount Sinai Medical Center, New York, New York 10029.

In nearly 25 years of clinical experience, the benefits and limitations of ketamine analgesia and anaesthesia have generally been well-defined. The extensive review of White et al. and the cardiovascular review of Reves et al. are broad in their scope and have advanced the understanding of dissociative anaesthesia. Nevertheless, recent research continues to illuminate different aspects of ketamine pharmacology, and suggests new clinical uses for this drug. The identification of the N-methylaspartate receptor gives further support to the concept that ketamine's analgesic and anaesthetic effects are mediated by separate mechanisms. The stereospecific binding of (+)ketamine to opiate receptors in vitro, more rapid emergence from anaesthesia, and the lower incidence of emergence sequelae, make (+)ketamine a promising drug for future research. Clinical applications of ketamine that have emerged recently, and are likely to increase in the future, are the use of oral, rectal, and intranasal preparations for the purposes of analgesia, sedation, and anaesthetic induction. Ketamine is now considered a reasonable option for anaesthetic induction in the hypotensive preterm neonate. The initial experience with epidural and intrathecal ketamine administration has not been very promising but the data are only preliminary in this area. The use of ketamine in military and catastrophic settings is likely to become more common. The clinical availability of midazolam will complement ketamine anaesthesia in several ways. This rapidly metabolized benzodiazepine reduces ketamine's cardiovascular stimulation and emergence phenomena, and does not have active metabolites. It is dispensed in an aqueous medium, which is usually non-irritating on intravenous injection, unlike diazepam. The combination of ketamine and midazolam is expected to achieve high patient acceptance, which never occurred with ketamine as a sole agent. Finally, it is necessary to point out the potential for abuse of ketamine. While ketamine is not a controlled substance (in the United States), the prudent physician should take appropriate precautions against the unauthorized use of this drug.


This article has been cited by other articles:


Home page
 Br J AnaesthHome page
W.-H. Chan, T.-L. Chen, R.-M. Chen, W.-Z. Sun, and T.-H. Ueng
Propofol metabolism is enhanced after repetitive ketamine administration in rats: the role of cytochrome P-450 2B induction
Br. J. Anaesth., September 1, 2006; 97(3): 351 - 358.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
R. E. Willoughby, K. S. Tieves, G. M. Hoffman, N. S. Ghanayem, C. M. Amlie-Lefond, M. J. Schwabe, M. J. Chusid, and C. E. Rupprecht
Survival after Treatment of Rabies with Induction of Coma
N. Engl. J. Med., June 16, 2005; 352(24): 2508 - 2514.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
T. Edrich, A. D. Friedrich, H. K. Eltzschig, and T. W. Felbinger
Ketamine for Long-Term Sedation and Analgesia of a Burn Patient
Anesth. Analg., September 1, 2004; 99(3): 893 - 895.
[Abstract] [Full Text] [PDF]

Home page
 Drug Metab. Dispos.Home page
M. L. Williams, D. E. Mager, H. Parenteau, G. Gudi, T. S. Tracy, M. Mulheran, and I. W. Wainer
EFFECTS OF PROTEIN CALORIE MALNUTRITION ON THE PHARMACOKINETICS OF KETAMINE IN RATS
Drug Metab. Dispos., August 1, 2004; 32(8): 786 - 793.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
M C Howes
Ketamine for paediatric sedation/analgesia in the emergency department
Emerg. Med. J., May 1, 2004; 21(3): 275 - 280.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
R G McGlone, M C Howes, and M Joshi
The Lancaster experience of 2.0 to 2.5 mg/kg intramuscular ketamine for paediatric sedation: 501 cases and analysis
Emerg. Med. J., May 1, 2004; 21(3): 290 - 295.
[Abstract] [Full Text] [PDF]

Home page
 Ann. N. Y. Acad. Sci.Home page
N. B. FARBER
The NMDA Receptor Hypofunction Model of Psychosis
Ann. N.Y. Acad. Sci., November 1, 2003; 1003(1): 119 - 130.
[Abstract] [Full Text] [PDF]

Home page
 AM J HOSP PALLIAT CAREHome page
M. Z. Al-Shahri, E. H. Molina, and D. Oneschuk
Medication-focused approach to total pain: Poor symptom control, polypharmacy, and adverse reactions
American Journal of Hospice and Palliative Medicine, July 1, 2003; 20(4): 307 - 310.
[Abstract] [PDF]

Home page
 J. Neurosci.Home page
K. C. Luk, T. E. Kennedy, and A. F. Sadikot
Glutamate Promotes Proliferation of Striatal Neuronal Progenitors by an NMDA Receptor-Mediated Mechanism
J. Neurosci., March 15, 2003; 23(6): 2239 - 2250.
[Abstract] [Full Text] [PDF]

Home page
 TraumaHome page
C. Gwinnutt, L. Bethelmy, and J. Nolan
Anaesthesia in trauma
Trauma, January 1, 2003; 5(1): 51 - 60.
[Abstract] [PDF]

Home page
 RadiologyHome page
K. P. Mason, E. Michna, J. A. DiNardo, D. Zurakowski, V. E. Karian, L. Connor, and P. E. Burrows
Evolution of a Protocol for Ketamine-induced Sedation as an Alternative to General Anesthesia for Interventional Radiologic Procedures in Pediatric Patients
Radiology, November 1, 2002; 225(2): 457 - 465.
[Abstract] [Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
T. Aye and B. Milne
Ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe COPD: [La ketamine utilisee pour l'anesthesie d'une ponction pericardique chez une patiente qui presente une tamponnade et une MPOC severe]
Can J Anesth, March 1, 2002; 49(3): 283 - 286.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
E Saarenmaa, P J Neuvonen, P Huttunen, and V Fellman
Ketamine for procedural pain relief in newborn infants
Arch. Dis. Child. Fetal Neonatal Ed., July 1, 2001; 85(1): F53 - 56.
[Abstract] [Full Text] [PDF]

Home page
 Drug Metab. Dispos.Home page
Y. Yanagihara, S. Kariya, M. Ohtani, K. Uchino, T. Aoyama, Y. Yamamura, and T. Iga
Involvement of CYP2B6 in N-Demethylation of Ketamine in Human Liver Microsomes
Drug Metab. Dispos., June 1, 2001; 29(6): 887 - 890.
[Abstract] [Full Text]

Home page
 Emerg. Med. J.Home page
J P Acworth, D Purdie, and R C Clark
Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation
Emerg. Med. J., January 1, 2001; 18(1): 39 - 45.
[Abstract] [Full Text]

Home page
 Arch Gen PsychiatryHome page
D. Umbricht, L. Schmid, R. Koller, F. X. Vollenweider, D. Hell, and D. C. Javitt
Ketamine-Induced Deficits in Auditory and Visual Context-Dependent Processing in Healthy Volunteers: Implications for Models of Cognitive Deficits in Schizophrenia
Arch Gen Psychiatry, December 1, 2000; 57(12): 1139 - 1147.
[Abstract] [Full Text] [PDF]

Home page
 Arch Gen PsychiatryHome page
D. C. Javitt, U. Heresco-Levy, N. B. Farber, J. W. Newcomer, and J. W. Olney
Are Glycine Sites Saturated In Vivo?
Arch Gen Psychiatry, December 1, 2000; 57(12): 1181 - 1183.
[Full Text] [PDF]

Home page
 JBJSHome page
E. C. McCarty, G. A. Mencio, L. A. Walker, and N. E. Green
Ketamine Sedation for the Reduction of Children's Fractures in the Emergency Department
J. Bone Joint Surg. Am., July 1, 2000; 82(7): 912 - 912.
[Abstract] [Full Text]

Home page
 Anesth. Analg.Home page
T. Yamakura, K. Sakimura, and K. Shimoji
The Stereoselective Effects of Ketamine Isomers on Heteromeric N-Methyl-D-Aspartate Receptor Channels
Anesth. Analg., July 1, 2000; 91(1): 225 - 229.
[Abstract] [Full Text] [PDF]

Home page
 ScienceHome page
C. Ikonomidou, F. Bosch, M. Miksa, P. Bittigau, J. Vöckler, K. Dikranian, T. I. Tenkova, V. Stefovska, L. Turski, and J. W. Olney
Blockade of NMDA Receptors and Apoptotic Neurodegeneration in the Developing Brain
Science, January 1, 1999; 283(5398): 70 - 74.
[Abstract] [Full Text]

Home page
 Arch Gen PsychiatryHome page
N. B. Farber, J. W. Newcomer, and J. W. Olney
Glycine Agonists: What Can They Teach Us About Schizophrenia?
Arch Gen Psychiatry, January 1, 1999; 56(1): 13 - 17.
[Full Text] [PDF]

Home page
 Arch Intern MedHome page
M. E. Serjeant and S. M. Grundy
The Key to Atherogenicity
Arch Intern Med, May 25, 1998; 158(10): 1156 - 1158.
[Full Text] [PDF]

Home page
 Clin. Chem.Home page
S. Bolze and R. Boulieu
HPLC determination of ketamine, norketamine, and dehydronorketamine in plasma with a high-purity reversed-phase sorbent
Clin. Chem., March 1, 1998; 44(3): 560 - 564.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
M. Rockoff, C. Cote, R. Kaplan;, D. Ertem, Y. Acar, E. Ozguven, E. Pehlivanoglu;, C. Bell;, R. I. Parker, R. A. Mahan, et al.
Sedation for Procedures
Pediatrics, December 1, 1997; 100(6): 1045 - 1045.
[Full Text] [PDF]

Home page
 StrokeHome page
K. W. Muir and K. R. Lees
Clinical Experience With Excitatory Amino Acid Antagonist Drugs
Stroke, March 1, 1995; 26(3): 503 - 513.
[Abstract] [Full Text]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1989 by the Canadian Anesthesiologists' Society.