title: Ketamine-Based Anesthetic Protocols and Evoked Potential Monitoring: A Risk/Benefit Overview.
abstract: Since its discovery, ketamine, a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist related to phencyclidine, has been linked to multiple adverse reactions sometimes described as "out of body" and "near death experiences," including emergence phenomena, delusions, hallucinations, delirium, and confusion. Due to these effects, ketamine has been withdrawn from mainstream anesthetic use in adult patients. Evoked potentials (EPs) are utilized to monitor neural pathways during surgery, detect intraoperative stress or damage, detect and define the level of neural lesions, and define abnormalities. Unfortunately, many of the volatile anesthetics commonly used during spinal and neurologic procedures suppress EP amplitude and monitoring. Ketamine has been found in several preclinical and clinical studies to actually increase EP amplitude and thus has been used as an analgesic adjunct in procedures where EP monitoring is critical. Once the gap in our knowledge of ketamine's risks has been sufficiently addressed in animal models, informed clinical trials should be conducted in order to properly incorporate ketamine-based anesthetic regimens during EP-monitored neurosurgeries.
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center Columbus, OH, USA.
authors.forename: Nicoleta
authors.initials: N
authors.lastname: Stoicea
authors.affiliation: College of Medicine, The Ohio State University Wexner Medical Center Columbus, OH, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Versteeg
authors.affiliation: Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, Romania.
authors.forename: Diana
authors.initials: D
authors.lastname: Florescu
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical CenterColumbus, OH, USA; Department of Neuroscience, The Ohio State UniversityColumbus, OH, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Joseph
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center Columbus, OH, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Fiorda-Diaz
authors.affiliation: Servicio de Anestesiologia, Clínica Cira García La Habana, Cuba.
authors.forename: Víctor
authors.initials: V
authors.lastname: Navarrete
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical CenterColumbus, OH, USA; Department of Neurosurgery, The Ohio State University Wexner Medical CenterColumbus, OH, USA.
authors.forename: Sergio D
authors.initials: SD
authors.lastname: Bergese
keywords: drug abuse; evoked potentials; general anesthesia; ketamine; motor evoked potentials; phencyclidine; somatosensory evoked potentials