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Wherefore ketamine?

Persson, Jan

Current Opinion in Anaesthesiology: August 2010 - Volume 23 - Issue 4 - p 455–460
doi: 10.1097/ACO.0b013e32833b49b3
Drugs in anesthesia: Edited by Klaus T. Olkkola

Purpose of review Ketamine has been repeatedly reviewed in this journal but novel developments have occurred in the last few years prompting an update. Interesting recent publications will be highlighted against a background of established knowledge.

Recent findings In the field of anesthesia, particularly in pediatrics, some contributions have been made concerning intramuscular versus intravenous induction. The need for anticholinergic adjuvants has also been clarified. Neuroapoptosis has been observed in animals and its implications for human subjects are discussed in a general context of neurotoxicity. The most important developments, however, are in the treatment of pain. Neurological and urological side effects strongly question long-term use. Other potentially beneficial effects have also been reported, such as anti-inflammatory and antidepressive effects. There are also indications that ketamine may attenuate postoperative delirium in coronary by-pass patients.

Summary More questions have arisen than have been answered. Some have very grave implications. The issue of neuroapoptosis must be clarified. The long-term effects must be further investigated. On the bright side the effects on postoperative delirium, as well as the anti-inflammatory and antidepressive effects, might open new vistas for an old drug.

Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Stockholm, Sweden

Correspondence to Jan Persson, MD, PhD, Pain Section, Dept of Anaesthesia, Karolinska University Hospital, Huddinge, 14186 Stockholm, Sweden Tel: +46 8 58580000; fax: +46 8 58586440; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.