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Something new about ketamine for pediatric anesthesia?

Lois, Fernande; De Kock, Marc

Current Opinion in Anesthesiology: June 2008 - Volume 21 - Issue 3 - p 340–344
doi: 10.1097/ACO.0b013e3282f82bde
Pediatric anesthesia: Edited by Bernard J. Dalens

Purpose of review This review discusses the place of the old anesthetic ketamine in pediatric anesthesia.

Recent findings Despite the availability of modern alternatives, ketamine remains a frequently used drug particularly for anesthesia in high-risk children and for procedures outside the operating room. In adult patients undergoing surgery, a renewed interest in this drug is noted. It is the consequence of recent demonstrations of the following effects. First, ketamine is highly effective against surgery and opiate-induced hyperalgesia. Second, it has original antiproinflammatory properties. In other words, it promotes self-limitation of the inflammatory response that follows surgery. In the pediatric population, these benefits wait to be confirmed. Finally, questions arise about the safety of ketamine anesthesia. Ketamine is a potent proapoptotic drug. In rodents treated during the critical period for central nervous system development, long-term behavioral deficits were noted after an anesthetic dose of ketamine. The exact consequences of these proapoptotic properties on human brain tissue development have to be exactly determined and are still debatable.

Summary Ketamine has not yet revealed all its interactions in humans. Recent discoveries indicate interesting properties on the one hand and potentially deleterious effects on the other.

Department of Anesthesia, Catholic University of Louvain, Brussels, Belgium

Correspondence to Marc De Kock, MD, PhD, Department of Anesthesia, Catholic University of Louvain, St Luc Hospital, 10-1821 av. Hippocrate, 1200 Brussels, Belgium Tel: +32 2 7641821; fax: +32 2 7643699; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.