Abstract
SummaryS(+)-ketamine, the pure dextrorotatory enantiomer of ketamine has been available for clinical use in analgesia and anesthesia for more than 25 years. The main effects are mediated by non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor but S(+)-ketamine also interacts with opioid receptors, monoamine receptors, adenosine receptors and other purinergic receptors. Effects on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, metabotropic glutamate receptors (mGluR) and L‑type calcium chanels have also been described. S(+)-ketamine stimulates the sympathetic nerve system, making it an ideal drug for analgosedation or induction of anesthesia in instable patients. In addition, the neuroprotective properties, bronchodilatory, antihyperalgesic or antiepileptic effects provide interesting therapeutic options. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care.
Highlights
Numerous beneficial properties predispose S(+)-ketamine for use as a single agent as well as in combination with other substances for prehospital and hospital-based emergency medicine but more than that it has become an essential part of current treatment concepts for many patients in intensive care, providing specific advantages for those with neurological disorders, bronchospasm, seizures and sepsis
Ketamine is a water and lipid soluble phencyclidine derivative used for anesthesia and sedation
The immediate effects of ketamine include the noncompetitive blockade of the NMDA subtype of the glutamate receptor, tonic inhibition of voltage-dependent sodium channels and blockade of acetylcholine receptors
Summary
Helmut Trimmel · Raimund Helbok · Thomas Staudinger · Wolfgang Jaksch · Brigitte Messerer · Herbert Schöchl · Rudolf Likar. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care. From the early 1990s S(+)-ketamine, as the pure dextrorotatory enantiomer of ketamine, has been available for clinical use in analgesia and anesthesia. Numerous beneficial properties predispose S(+)-ketamine for use as a single agent as well as in combination with other substances for prehospital and hospital-based emergency medicine but more than that it has become an essential part of current treatment concepts for many patients in intensive care, providing specific advantages for those with (traumatic) neurological disorders, bronchospasm, seizures and sepsis. This article sheds light on the recent value of S(+)-ketamine in these two specific areas, emergency medicine as well as critical care under pharmacological and clinical aspects. Emphasis is placed on evidence-based as well as expert opinions for the use of this drug in (pediatric) anesthesia, pain medicine and psychiatry (e. g. therapy of treatment-resistant depression)
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