Aubree Baranowski

March 31, 2019

Lindhardt

Ketamine in Medicine

Ketamine was approved as a class III medication by the FDA in 1970. It closely relates to

the hallucinogenic drug called PCP, also known as phencyclidine. Although it is a great

anesthetic, it can cause serious neuropsychiatric affects like delirium and psychosis dissociative

states (Modern Language Assoc). In the 1990’s, ketamine started being used recreationally, and

has often been referred to as a horse tranquilizer. Even with the increased abuse by users, clinical

experiments of ketamine have grown significantly. The reason is because ketamine can also help

with pain management for burn victims going through skin graphs and has helped sedate patients

with depression and alcohol withdrawal symptoms. It has even been used to help treat people

with epilepsy.

Ketamine affects the brain by slowing down neuropathy responses to pain and can also

affect opioid receptors. This significantly reduces pain for patients without the use of heavy

narcotics. Ketamine is used intravenously, but some may use it as an intramuscular injection to

help with acute pain (Modern Language Assoc). Other routes of administration include; rectally,

subcutaneously, and nasally. The extent of absorption, onset, and duration depends on the route

of administration and the amount used (Modern Language Assoc).

Intravenously is the most commonly used route of administration, especially in critical

care and intensive care practices because of the quick onset of anesthesia and pain relief.

Ketamine is used in the intensive care units to help reduce the amount of morphine needed to
help the patient maintain pain control. It is also less likely to cause opioid dependence compared

to other types of pain medications. In a study conducted by Dr. Weinbroum, he gave patients

coming out of major surgeries either morphine, or a combination of less morphine and ketamine

solutions. The patients were allowed to take an additional dose of diclofenac, an NSAID, if

needed for pain control. His findings concluded that the patients with the morphine and ketamine

combination asked for fewer injections than the morphine only patients. They were also less

likely to ask for addition pain relief via diclofenac. The periods between injections were also a

lot longer than the patients with only morphine for pain control. The methadone only patients

asked for more frequent injections of morphine and also for more diclofenac to help with their

pain.

Not very many doctors want to use ketamine for treatment because there is not a lot of

studies in favor of the medication. Most publications talk about how it is being used on the street

as a hallucinogenic and can cause serious addiction. However, information found from ketamine

studies suggest that ketamine may have a role in pain control for patients who are critically ill.

This allows for fewer pain medications to be taken and especially for fewer opioids. Reducing

opioid consumption also reduces opioid side effects. They include; constipation, nausea,

vomiting, ileus, and tolerance to opioids (Modern Language Assoc).

Ketamine is commonly used for patients who have hypotension because it increases

blood pressure, but not cardio input. Other sedative medications typically slow heart and blood

pressure, making it very dangerous for those with low blood pressure, or people who are

hypotensive. It is also better for patients who are hemophiliacs or are on blood thinners because

it doesn’t affect the platelets like common anesthesia can.

 The quick onset of pain reduction and sedative properties using ketamine is great for

short and painful procedures. Ketamine also helps reduce agitation and anxiety. A beneficial side

effect for patients who experienced trauma or severe pain is amnesia. This can help patients to

not develop Post Traumatic Stress Disorder from painful or scary procedures. Opioids cause a

reduction in airways and slows breathing, where ketamine actually preserves airway muscle tone,

dilates bronchial smooth muscle, and promotes spontaneous breathing (Modern Language

Assoc).

Using Ketamine can be very beneficial, but the side effects of stopping ketamine

treatments comes with its own risks. Stopping ketamine can cause lower oxygen content in the

blood and patients should be monitored after doses have ceased. Especially how the ribs and

lungs contract with each breath (Modern Language Assoc). It can also increase cranial pressure,

so it is not recommended or desirable for patients who are undergoing cranial or spinal surgeries

because it causes more potential risks and problems with function in the body. The use of

prescribing ketamine should be by a case-by-case basis. Another side effect of stopping ketamine

treatment is agitation and disorientation so it is recommended that patients also have a rescue

dose of a benzodiazepine such as clonazepam or alprazolam to treat come-down symptoms.

Newly developed medication for the use of depression via intranasal ketamine dosing is

new to pharmacology. The patient only needs to come in for one dose a month to help with

severe depression. The patient is also required to already be taking an SSRI (selective serotonin

reuptake inhibitor) to qualify for treatment. This medication is newly to the market and most

insurances do not cover this medication.

Its interesting to me that ketamine can have so many beneficial outcomes but is rejected

based off of the lack of studies. The studies are not being conducted because of the lack of
knowledge of the drug. I hope that in the future ketamine can be used to help those with

depression, as well as those with severe pain to help alleviate the opioid epidemic the world is

facing today.

Alexander, Earnest, et al. “Ketamine Use in the Intensive Care Unit.” AACN Advanced Critical

Care, vol. 29, no. 2, Summer 2018, pp. 101–106. EBSCOhost,

doi:10.4037/aacnacc2018448.