Ketamine, a general anaesthetic agent and more. A review on its use in and out the clinical setting

  • C. Ori
  • M. Dalsasso
  • U. Freo
Conference paper


Ketamine is a non-competitive NMDA receptors antagonist with potent general anaesthetic and analgesic effects. NMDA receptors are involved in nociceptive modulation, in the wind-up phenomenon, in peripheral receptive fields expansion, in primary and secondary hyperalgesia, and in neuronal plasticity, a process implicated in central sensitisation of pain [1]. Ketamine also acts on nicotinic and muscarinic receptors, blocks sodium channels and interacts with µ, δ and κ opioid receptors.


Cancer Pain Postherpetic Neuralgia Status Asthmaticus Club Drug Intravenous Ketamine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adam F, Libier M, Oszustowicz T et al (1999) Preoperative small-dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy. Anesth Analg 89: 444–447PubMedGoogle Scholar
  2. 2.
    Reich DL, Silvay G (1989) Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth 36: 186–197PubMedCrossRefGoogle Scholar
  3. 3.
    Maurset A, Oye I (1990) Ketamine: clinically useful–pharmacologically interesting. Nord Med 105: 182–183PubMedGoogle Scholar
  4. 4.
    Ivani G, Vercellino C, Tonetti F (2003) Ketamine: a new look to an old drug. Minerva Anestesiologica 69: 468–471PubMedGoogle Scholar
  5. 5.
    White PF, Way WL, Trevor AJ (1982) Ketamine–its pharmacology and therapeutic uses. Anesthesiology 56: 119–136PubMedCrossRefGoogle Scholar
  6. 6.
    Reyes JG, Flezzani P, Kissin I(1987) Intravenous anesthetic induction drugs. In: Kaplan JA (ed) Cardiac Anesthesia. Grune and Stratton, New York, pp 466–469Google Scholar
  7. 7.
    Domino EF, Chodoff P, Corssen G (1965) Pharmacologic effects of CI-581, a new dissociative anesthetic in man. Clin Pharmacol Ther 6: 279–291PubMedGoogle Scholar
  8. 8.
    David L, Reich MD, Silvay G (1989) Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth 36: 186–197CrossRefGoogle Scholar
  9. 9.
    Restall J, Tully PJ, Ward PJ et al (1988) Total intravenous anaesthesia for military surgery. A technique using ketamine, midazolam and vecuronium. Anaesthesia 43: 46–49PubMedCrossRefGoogle Scholar
  10. 10.
    Bailie R, Craig G, Restall J (1989) Total intravenous anaesthesia for laparoscopy. Anaesthesia 44: 60–63PubMedCrossRefGoogle Scholar
  11. 11.
    Takrouri MS (1999) Anesthesia for laparoscopie general surgery. A special review. Middle East J Anesthesiol 15: 39–62PubMedGoogle Scholar
  12. 12.
    Matsuki A (1991) A review of recent advances in total intravenous anesthesia. Masui 40: 684–691PubMedGoogle Scholar
  13. 13.
    Parker MJ, Handoll HH, Griffiths R (2001) Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev CD000521Google Scholar
  14. 14.
    Aye T, Milne B (2002) Ketamine anesthesia for pericardial window in a patient with pericardial tamponade and severe COPD. Can J Anaesth 49: 283–286PubMedCrossRefGoogle Scholar
  15. 15.
    Roytblat L, Korotkoruchko A, Katz J et al (1993) Postoperative pain: the effect of a low-dose ketamine in addition to general anesthesia. Anesth Analg 77: 1161–1165PubMedCrossRefGoogle Scholar
  16. 16.
    Fu ES, Miguel R, Scharf JE (1997) Preemptive ketamine decreases postoperative narcotic requirements in patients undergoing abdominal surgery. Anesth Analg 84: 1086–1090PubMedGoogle Scholar
  17. 17.
    Wilder-Smith OHG, Arendt-Nielsen L, Gäumann D et al (1998) Sensory changes and pain after abdominal hysterectomy: a comparison of anesthetic supplementation with fentanyl versus magnesium or ketamine. Anesth Analg 86: 95–101PubMedGoogle Scholar
  18. 18.
    Suzuki M, Tsueda K, Lansing PS et al (1999) Small-dose ketamine enhances morphine-induced analgesia after outpatient surgery. Anesth Analg 89: 98–103PubMedGoogle Scholar
  19. 19.
    Menigaux C, Fletcher D, Dupont X et al (2000) The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg 90: 129–135PubMedCrossRefGoogle Scholar
  20. 20.
    Wilder-Smith OH (1995) Pre-emptive analgesia. Anaesthesist 44 Suppl 3: S529 - S534Google Scholar
  21. 21.
    Sandler AN (1999) Post-thoracotomy analgesia and perioperative outcome. Minerva Anestesiol 65: 267–274PubMedGoogle Scholar
  22. 22.
    Conacher ID (2001) Post-thoracotomy analgesia. Anesthesiol Clin North America 19: 611–625PubMedCrossRefGoogle Scholar
  23. 23.
    Taura P, Fuster J, Blasi A et al (2003) Postoperative pain relief after hepatic resection in cirrhotic patients: the efficacy of a single small dose of ketamine plus morphine epidurally. Anesth Analg 96: 475–480PubMedCrossRefGoogle Scholar
  24. 24.
    Astuto M, Disma N, Crimi E (2002) Two doses of oral ketamine, given with midazolam, for premedication in children. Minerva Anestesiol 68: 593–598PubMedGoogle Scholar
  25. 25.
    Turhanoglu S, Kararmaz A, Ozyilmaz MA et al (2003) Effects of different doses of oral ketamine for premedication of children. Eur J Anaesthesiol 20: 56–60PubMedCrossRefGoogle Scholar
  26. 26.
    Bergman SA (1999) Ketamine: review of its pharmacology and its use in pediatric anesthesia. Anesth Prog 46: 10–20PubMedGoogle Scholar
  27. 27.
    Pun MS, Thakur J, Poudyal G et al (2003) Ketamine anaesthesia for paediatric ophthalmology surgery. Br J Ophthalmol 87: 535–537PubMedCrossRefGoogle Scholar
  28. 28.
    Law AK, Ng DK, Chan KK (2003) Use of intramuscular ketamine for endoscopy sedation in children. Pediatr Int 45: 180–185PubMedCrossRefGoogle Scholar
  29. 29.
    Marhofer P, Koinig H, Kapral S (2003) The choice of drugs for caudal anaesthesia in children. An overview. Anaesthesist 52: 55–67Google Scholar
  30. 30.
    Ozbek H, Bilen A, Ozcengiz D et al (2002) The comparison of caudal ketamine, alfentanil and ketamine plus alfentanil administration for postoperative analgesia in children. Paediatr Anaesth 12: 610–616PubMedCrossRefGoogle Scholar
  31. 31.
    Kruger AD (1998) Current aspects of using ketamine in childhood. Anaesthesiol Reanim 23: 64–71PubMedGoogle Scholar
  32. 32.
    Baraka AS, Sayyd SS, Assaf BA (1997) Thiopental-rocuronium versus ketamine-rocuronium rapid-sequence intubation in parturients undergoing cesarean section. Anesth Analg 84: 1104–1107PubMedGoogle Scholar
  33. 33.
    Yaubihi N, Oberoi GS (1994) Comparison of conventional anaesthesia, total intravenous ketamine and epidural block for abdominal hysterectomy. P N G Med J 37: 209–213PubMedGoogle Scholar
  34. 34.
    Adams HA, Meyer P, Stoppa A et al (2003) Anaesthesia for caesarean section. Comparison of two general anaesthetic regimens and spinal anesthesia. Anaesthesist 52: 23–32PubMedCrossRefGoogle Scholar
  35. 35.
    Kee WD, Khaw KS, Ma ML et al (1997) Postoperative analgesic requirement after cesarean section: a comparison of anesthetic induction with ketamine or thiopental. Anesth Analg 85: 1294–1298Google Scholar
  36. 36.
    Hee WC, Metias VF (2001) Intramuscular Ketamine in a parturient in whom pre-operative intravenous access was not possible. Br J Anaesth 86: 891–893PubMedCrossRefGoogle Scholar
  37. 37.
    Bonanno FG (2002) Ketamine in war/tropical surgery (a final tribute to the racemic mixture). Injury 33: 323–327PubMedCrossRefGoogle Scholar
  38. 38.
    Ezri T, Szmuk P, Stein A et al (2000) Peripartum general anaesthesia without tracheal intubation. Anaesthesia 55: 421–426PubMedCrossRefGoogle Scholar
  39. 39.
    Altissimi C (1979) Ketamine and analgesia during labor. Minerva Anestesiol 45: 907–914PubMedGoogle Scholar
  40. 40.
    Adams HA, Hemelmann G (1990) 20 years of ketamine-a backward look. Anaesthesist 39: 71–76Google Scholar
  41. 41.
    Friedberg BL (2003) Propofol ketamine anesthesia for cosmetic surgery in the office suite. Int Anesthesiol Clin 41:39–5012–5013Google Scholar
  42. 42.
    White PF (2002) The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg 94: 577–585PubMedCrossRefGoogle Scholar
  43. 43.
    Darvas K, Janecsko M, Vimlati L et al (1999) Anesthesia ambulatory one-day surgery. Ory Hetil 140: 2035–2040Google Scholar
  44. 44.
    Vinnik CA (1981) An intravenous dissociation technique for outpatient plastic surgery: tranquillity in the office surgical facility. Plast Reconstr Surg 67: 799–805PubMedCrossRefGoogle Scholar
  45. 45.
    Liang HS, Liang HG (1975) Minimizing emergence phenomena: subdissociative dosage of ketamine in balanced surgical anesthesia. Anesth Analg 54: 312–316PubMedCrossRefGoogle Scholar
  46. 46.
    Roytblat L, Levy J, Goldstein J et al (1986) Balanced anesthesia: low-dose ketamine/neuroleptoanalgesia. Curr Ther Res 40: 646–652Google Scholar
  47. 47.
    Menigaux C, Fletcher D, Dupont X et al (2000) The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg 90: 129–135PubMedCrossRefGoogle Scholar
  48. 48.
    Mathisen LC, Aasbo V, Reder J (1999) Lack of pre-emptive analgesic effect of (R)-ketamine in laparoscopie cholecystectomy. Acta Anaesthesiol Scand 43: 220–224PubMedCrossRefGoogle Scholar
  49. 49.
    Doak GJ, Duke PC (1993) Oral clonidine premedication attenuates the haemodinamic effects associated with ketamine anaesthetic induction in humans. Can J Anaesth 40: 612–618PubMedCrossRefGoogle Scholar
  50. 50.
    Tanaka M, Nishikawa T (1994) Oral clonidine premedication attenuates the hypertensive response to ketamine. Br J Anaesth 73: 758–762PubMedCrossRefGoogle Scholar
  51. 51.
    Taittonen MT, Kirvelä OA, Aantaa R et al (1998) The effect of clonidine or midazolam premedicationonperioperativeresponsesduringketamineanesthesia.AnesthAnalg 87: 161–167PubMedGoogle Scholar
  52. 52.
    Handa F, Tanaka M, Nishikawa T et al (2000) Effect of oral clonidine premedication on side effects of intravenous ketamine anesthesia: a randomized, double-blind, placebo-controlled study. J Clin Anesth 12: 19–24PubMedCrossRefGoogle Scholar
  53. 53.
    Cartwright PD, Pingel SM (1984) Midazolam and diazepam in ketamine anaesthesia. Anaesthesia 39: 439–442PubMedCrossRefGoogle Scholar
  54. 54.
    White PF (1983) Use of continuous infusion versus intermittent bolus administration of fentanyl or ketamine during outpatient anesthesia. Anesthesiology 59: 294–300PubMedCrossRefGoogle Scholar
  55. 55.
    Mankowitz E, Brock-Utne JG, Cosnett JE et al (1982) Epidural ketamine. A preliminary report: S Afr Med J 61: 441–442PubMedGoogle Scholar
  56. 56.
    Rawal N (1995) Spinal antinociception: clinical aspects. Ann Med 27: 263–268PubMedCrossRefGoogle Scholar
  57. 57.
    Brock-Utne JG, Kallichurum S. Mankowitz E et al (1982) Intrathecal ketamine with preservative-histological effects on spinal nerve roots of baboons. S Afr Med J 61: 440–441PubMedGoogle Scholar
  58. 58.
    Gebhardt B (1994) Pharmacology and clinical results with peridural and intrathecal administration of ketamine. Anaesthesist 43 Suppl 2: S34 - S40Google Scholar
  59. 59.
    Bion JF (1984) Intrathecal ketamine for war surgery. A preliminary Study under field conditions. Anaesthesia 39: 1023–1028PubMedCrossRefGoogle Scholar
  60. 60.
    McDonnell FJ, Sloan JW, Hamann SR (2000) Advances in cancer pain management. Curr Oncol Rep 2: 351–357PubMedCrossRefGoogle Scholar
  61. 61.
    Bell R, Eccleston C, Kalso E (2003) Ketamine as an adjuvant to opioids for cancer pain. Cochrane Database Syst Rev 2003: CD003351Google Scholar
  62. 62.
    McQueen AL, Baroletti SA (2002) Adjuvant ketamine analgesia for the management of cancer pain. Ann Pharmacother 36 (10): 1614–1619PubMedCrossRefGoogle Scholar
  63. 63.
    Kannan TR, Saxena A, Bhatnagar S et al (2002) Oral ketamine as an adjuvant to oral morphine for neuropathie pain in cancer patients. J Pain Symptom Manage 23: 60–65PubMedCrossRefGoogle Scholar
  64. 64.
    Fitzgibbon EJ, Hall P, Schroder C et al (2002) Low dose ketamine as an analgesic adjuvant in difficult pain syndromes: a strategy for conversion from parenteral to oral ketamine. Pain Symptom Manage 23: 165–170CrossRefGoogle Scholar
  65. 65.
    Vick PG, Lamer TJ (2001) Treatment of central post-stroke pain with oral ketamine. Pain 92: 311–313PubMedCrossRefGoogle Scholar
  66. 66.
    Mizuno J, Sugimoto S, Ikeda M et al (2001) Usefulness of epidural administration of ketamine for relief of postherpetic neuralgia. Masui 50: 904–907PubMedGoogle Scholar
  67. 67.
    Jago RH, Thompson MC (1984) Ketamine and military anaesthesia. The effect of heavy papaverum premedication and althesin induction on the incidence of emergence phenomena. Anaesthesia 39: 925–927PubMedCrossRefGoogle Scholar
  68. 68.
    Restall J, Tully AM, Ward PJ et al (1988) Total intravenous anaesthesia for military surgery. A technique using ketamine, midazolam, and vecuronium. Anaesthesia 43: 46–49PubMedCrossRefGoogle Scholar
  69. 69.
    Bishop RA, Litch JA, Stanton JM (2000) Ketamine anesthesia at high altitude. High Alt Med Biol. 1: 111–114PubMedCrossRefGoogle Scholar
  70. 70.
    White PF (1988) Ketamine update: its clinical uses in anesthesia. Seminars in Anesthesia 7: 113–126Google Scholar
  71. 71.
    Hennenberger A, Partecke BD (1995) Therapy of the severely burned child from the intensive care viewpoint. Unfallchirurg 98: 193–197PubMedGoogle Scholar
  72. 72.
    Byer DE, Gould AB (1981) Development of tolerance to ketamine in an infant undergoing repeated anesthesia. Anesthesiology 54: 255–256PubMedCrossRefGoogle Scholar
  73. 73.
    Garcia Martinez JM (1999) Round table: Severe asthma in pediatrics: treatment of acute crises. Allergol Immunopathol (Madr) 27: 53–62Google Scholar
  74. 74.
    Beveridge RC, Grunfeld AF, Hodder RV et al (1996) Guidelines for the emergency management of asthma in adults. CAEP/CTS Asthma Advisory Committee. Canadian Association of Emergency Physicians and The Canadian Society. CMAJ 155: 25–37PubMedGoogle Scholar
  75. 75.
    Lau TT, Zed PJ (2001) Does ketamine have a role in managing severe exacerbation of asthma in adults? Pharmacotherapy 21: 1100–1106PubMedCrossRefGoogle Scholar
  76. 76.
    Howton JC, Rose J, Duffy S, et al (1996) Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma. Ann Emerg Med 27: 170–175PubMedCrossRefGoogle Scholar
  77. 77.
    Sarma VJ (1992) Use of ketamine in acute severe asthma. Acta Anaesthesiol Scand 36: 106–107PubMedCrossRefGoogle Scholar
  78. 78.
    Jorgensen BG (1992) Ketamine as a broncholytic agent in status asthmaticus and as an anesthetic for patients with bronchial asthma. Ugeskr Laeger 154: 2132–2135PubMedGoogle Scholar
  79. 79.
    Strube PJ, Hallam PL (1986) Ketamine by continuous infusion in status asthmaticus. Anesthesia 41: 1017–1019CrossRefGoogle Scholar
  80. 80.
    Hemmingsen C, Nielsen PK, Odorico J (1994) Ketamine in the treatment of bronchospasm during mechanical ventilation. Am J Emerg Med 12: 417–420PubMedCrossRefGoogle Scholar
  81. 81.
    Rock MJ, Reyes de la Rocha S, L’Hommedieu CS et al (1986) Use of ketamine in asthmatic children to treat respiratory failure refractory to conventional therapy. Crit Care Med 14: 514–516PubMedCrossRefGoogle Scholar
  82. 82.
    Nehama J, Pass R, Bechtler-Karsch A (1996) Continuous ketamine infusion for the treatment of refractory asthma in a mechanically ventilated infant: case report and review of the pediatric literature. Pediatr Emerg Care 12: 294–297PubMedCrossRefGoogle Scholar
  83. 83.
    Petrillo TM, Fortenberry JD, Linzer JF (2001) Emergency department use of ketamine in pediatric status asthmaticus. J Asthma 38: 657–664PubMedCrossRefGoogle Scholar
  84. 84.
    Youssef-Ahmed MZ, Silver P, Nimkoff L et al (1996) Continuous infusion of ketamine in mechanically ventilated children with refractory bronchospasm. Intensive Care Med 22: 972–976PubMedCrossRefGoogle Scholar
  85. Gremmelt A, Braun U (1995) Analgesia and sedation in patients with head-brain trauma. Anaesthesist 44 Suppl 3: S559 - S665Google Scholar
  86. 86.
    Fitzal S (1997) Ketamine and neuroprotection. Clinical outlook. Anaesthesist 46 Suppl 1: S65 - S70Google Scholar
  87. 87.
    Mangini M (1998) Treatment of alcoholism using psychedelic drugs: a review of the program of research. J Psychoactive Drugs 30: 381–418PubMedCrossRefGoogle Scholar
  88. 88.
    Krupitsky EM, Grinenko AY (1997) Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. J Psychoactive Drugs 29: 165–183PubMedCrossRefGoogle Scholar
  89. 89.
    Grinenko AIa, Krupitskii EM, Palei AI et al (1989) Treatment of alcoholism by affective counterattribution. Zh Nevropatol Psikhiatr Im S S Korsakova. 89: 101–105PubMedGoogle Scholar
  90. 90.
    Sivolap IuP, Savchenkov VA (1994) Experience in using ketamine preparations in the psychotherapy of alcoholism. Zh Nevropatol Psikhiatr Im S S Korsakova 94: 76–79Google Scholar
  91. 91.
    Krupitsky E, Burakov A, Romanova T et al (2002) Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up. Subst Abuse Treat 23: 273–283CrossRefGoogle Scholar
  92. 92.
    Grieco A, Bloom R (1981) Psychotherapy with hallucinogenic adjuncts from a learning perspective. Int J Addict 16: 801–827PubMedGoogle Scholar
  93. 93.
    Smith KM, Larive LL, Romanelli F (2002) Club drugs: methylenedioxymethamphetamine, flunitrazepam, ketamine hydrochloride, and gamma-hydroxybutyrate. Am J Health Syst Pharm 59: 1067–1076PubMedGoogle Scholar
  94. 94.
    Jansen KL (2000) A review of the nonmedical use of ketamine: use, users and consequences. J Psychoactive Drugs 32: 419–433PubMedCrossRefGoogle Scholar
  95. 95.
    Bowdle TA, Radant AD, Cowley DS et al (1998) Psychedelic effects of ketamine in healthy volunteers: relationship to steady-state plasma concentrations. Anesthesiology 88: 82–88PubMedCrossRefGoogle Scholar
  96. 96.
    Curran HV, Morgan C (2000) Cognitive, dissociative and psychotogenic effects of ketamine in recreational users on the night of drug use and 3 days later. Addiction 95: 575–590PubMedCrossRefGoogle Scholar
  97. 97.
    Jansen KL (1990) Ketamine–can chronic use impair memory? Int J Addict 25: 133–139PubMedGoogle Scholar
  98. 98.
    Gaulier JM, Canal M, Pradeille JL et al (2002) New drugs at “rave parties”: ketamine and prolintane. Acta Clin Belg Suppl (1):41–46Google Scholar
  99. 99.
    Dalgarno PJ, Shewan D (1996) Illicit use of ketamine in Scotland. Psychoactive Drugs 28: 191–199Google Scholar
  100. 100.
    Lim DK (2003) Ketamine associated psychedelic effects and dependence. Singapore Med J 44: 31–34PubMedGoogle Scholar
  101. 101.
    Jansen KL, Darracot-Cankovic R (2001) The nonmedical use of ketamine, part two: A review of problem use and dependence. Psychoactive Drugs 33: 151–158CrossRefGoogle Scholar
  102. 102.
    Arditti J, Spadari M, de Haro L et al (2002) Ketamine - dreams and realities. Acta Clin Belg Suppl (1):31–33Google Scholar
  103. 103.
    Pal HR, Berry N, Kumar R et al (2002) Ketamine dependence. Anaesth Intensive Care 30: 382–384PubMedGoogle Scholar
  104. 104.
    Kapur S, Seeman P (2002) NMDA receptor antagonists ketamine and PCP have direct effects on the dopamine D9 and serotonin 5-HT, receptors-implications for models of schizophrenia. Mol Psychiatry 7: 837–844PubMedCrossRefGoogle Scholar
  105. 105.
    Micallef J, Tardieu S, Gentile S (2003) Effects of a subanaesthetic dose of ketamine on emotional and behavioral state in healthy subjects. Neurophysiol Clin 33: 138–147PubMedCrossRefGoogle Scholar
  106. 106.
    Carpenter WT Jr (1999) The schizophrenia ketamine challenge study debate. Biol Psychiatry 46: 1081–1091PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia, Milano 2004

Authors and Affiliations

  • C. Ori
  • M. Dalsasso
  • U. Freo

There are no affiliations available

Personalised recommendations