Ketamine: new indications for an old drug.
Ketamine is a non-competitive antagonist to the phencyclidine site of N-methyl-d-aspartate (NMDA) receptor for glutamate, though its effects are mediated by interaction with many others receptors. It has been introduced in clinical use since 1960's but today it is not largely employed as a general anaesthetic for its undesired psychic effects (emergence reactions) occurring in approximately 12% of patients. In the last decade, there has been a renewed interest in the use of subanaesthetic doses of ketamine for the treatment of acute and chronic pain. In the late 1990's, multiple prospective, randomised, controlled study has shown the efficacy of low dose of ketamine for postoperative pain relief, for analgesia during regional or local anaesthesia, and for opioid-sparing effect. At present, non-definitive conclusion can be drawn. More data are needed to define the possible long term effects and the clinical goal of ketamine use.
Annetta
Maria Giuseppina
MG
Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy. mgannetta@tin.it
Iemma
Domenico
D
Garisto
Cristiana
C
Tafani
Chiara
C
Proietti
Rodolfo
R
D000758:Anesthesia; D000772:Anesthesia, Local; D000778:Anesthetics, Dissociative / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007649:Ketamine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy; D011997:Recovery Room
D000778:Anesthetics, Dissociative; D007649:Ketamine