Ketamine and neurotoxicity: clinical perspectives and implications for emergency medicine.
Rodent and monkey research has shown that ketamine can induce accelerated programmed nerve cell death (apoptosis) when administered in high doses, for prolonged periods, or both. Concern about similar neurotoxicity with human therapeutic use has prompted ongoing investigations by the Food and Drug Administration and National Institutes of Health. If the results of these inquiries are unfavorable to ketamine, such action could ultimately lead to restricted availability of this drug or even its discontinuation from the market. This article discusses the limitations of the published animal research, the challenges in extrapolating such data to humans, the need for further animal and human investigations, and the potential adverse effect on current clinical practice that might result, should the use of ketamine be restricted or the drug removed from the market.
Green
Steven M
SM
Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA. steve@viridissimo.com
Coté
Charles J
CJ
D000778:Anesthetics, Dissociative / Q000009:adverse effects* / Q000494:pharmacology; D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D002648:Child; D004635:Emergency Medicine; D006801:Humans; D007649:Ketamine / Q000009:adverse effects* / Q000494:pharmacology; D009410:Nerve Degeneration / Q000139:chemically induced; D009474:Neurons / Q000378:metabolism; D020258:Neurotoxicity Syndromes / Q000209:etiology*
D000778:Anesthetics, Dissociative; D007649:Ketamine