Effects of enzyme induction, renal and cardiac function on ketamine plasma kinetics in patients with ketamine long-term analgosedation

  • C. Köppel
  • I. Arndt
  • K. Ibe
Original Papers


Steady-state plasma levels of ketamine and its metabolites norketamine and dehydronorketamine were determined in 4 different groups of a total of 27 patients with ketamine long-term analgosedation (1.1 – 1.3 mg/kg/h). In 9 of the patients who had normal liver and kidney function (group 1), steady-state levels after 3 days of continuous infusion were 1.2±0.3 μg/ml ketamine, 1.0±0.6 μg/ml norketamine, and 2.6±1.0 μg/ml dehydronorketamine. The measured ketamine levels in group 1 were in agreement with the expected value, which may be calculated from published pharmacokinetic data after bolus injection. In 8 patients with acute renal failure (group 2), a tendency to about 20% higher ketamine steady-state plasma levels compared to group 1 was observed, but this difference was not significant. However, dehydronorketamine plasma levels were significantly higher in this group. Only a manor fraction of the ketamine dose (10% and 4%) was eliminated during hemodialysis or hemofiltration treatment, respectively. Steady-state plasma levels in 5 patients with cardiogenic shock (group 3) did not differ significantly from those of group 1. In 5 patients with long-term use of barbiturates (group 4), steady-state plasma levels of ketamine were significantly lower compared to groups 1 and 3, most likely due to barbiturate-induced enzyme induction.

Hyperdynamic circulatory reactions were not observed in any of the patients. Psychomimetic effects could be excluded in 16 of the patients and were unlikely in 6 patients. In 5 further patients, psychomimetic effects could not definitely be excluded due to difficulties in non-verbal communication.


Ketamine long-term analgosedation plasmakinetics kidney liver heart function 


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Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • C. Köppel
    • 1
  • I. Arndt
    • 2
  • K. Ibe
    • 1
  1. 1.ReanimationszentrumUniversitätsklinikum Rudolf Virchow, Standort Charlottenburg, Freie Universität BerlinBerlinGermany
  2. 2.Abteilung Toxikologie, Landesuntersuchungsinstitut für LebensmittelArzneimittel und Tierseuchen BerlinBerlinGermany

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