Ketamine: Variable Uses in Medicine

Mini Review

Austin J Anesthesia and Analgesia. 2017; 5(3): 1063.

Ketamine: Variable Uses in Medicine

Sabia M¹*, Kudur V¹ and Reddy A²

¹Department of Anesthesiology, Cooper University Hospital, USA

²Department of Emergency Medicine, Cooper University Hospital, USA

*Corresponding author: Sabia M, Department of Anesthesiology, Cooper University Hospital, USA

Received: November 06, 2017; Accepted: November 28; 2017; Published: December 05, 2017


Ketamine over the years has found its primary use in the setting of analgesia but recently studies have shown a spectrum of applications that range in a variety of specialties. The most profound utility is demonstrated in its application in acute and chronic pain, both of which has been addressed previously with opioids over the years. A more novel approach has been in the area of psychiatry where ketamine has found application in a variety of pathologies from depression to PTSD. The benefit is not only found in the efficacy of the intervention but the possible reduction of the side effect profile versus the standard of care. Further exploration of ketamine’s use in medicine will only build upon what we know and drive future application.

Keywords: Ketamine; Pain; Psychiatry; Depression; Acute; Chronic


Ketamine has a variety of uses in both acute and chronic pain, as well as sedation. In addition to its known effect on pain, recent studies are showing its use in psychiatric conditions as well. Despite ketamine’s benefits in clinical use, its precise mechanism still remains unknown. It is believed to act as NMDA and HCN1 receptors antagonist and possesses positive and negative modulatory role on analgesia and sedation. Chronic pain is often managed with ketamine for its hyper-glutamatergic properties in which the effects of the drug outlast the levels of the drug itself [1].


Ketamine has been in use for nearly half a century as it produces a multitude of effects with dissociative anesthesia properties. The spectrum of effects includes hypnosis, anti-nociception, increased sympathetic activity, and maintenance of the airway [2].

Ketamine causes dependent blockade of the NMDA receptor which creates a blockade of the excitatory synaptic activity. This in turn creates a loss of responsiveness that allows it to aid in several clinical scenarios from acute and chronic pain to the most recent- as an antidepressant [1].

It has been shown that the effects of ketamine remain long after the drug has been excreted from the body, which makes it necessary to create a dose-response curve. This dose-response curve can be affected by a variety of factors. For instance, if the drug has a specific response in its molecular state in the lab, there must be a reason that same effect is not occurring in living organisms. One of the theories includes ketamine’s inability to penetrate the blood-brain barrier, or the presence of enzymes causing metabolism of the drug itself.

Molecular Actions of Ketamine

At concentrations within the clinical dose range, ketamine is now known to directly affect a wide range of cellular processes - including blockade of NMDA channels, nicotinic ACh channels, delta and muopioid and the nitric-oxide (NO)- cyclic guanosine-mono-phosphate (cGMP) system (Figure 1) [3].

Citation: Sabia M, Kudur V and Reddy A. Ketamine: Variable Uses in Medicine. Austin J Anesthesia and Analgesia. 2017; 5(3): 1063.