R. N. Harden
Feb 1, 2012
Citations
0
Influential Citations
3
Citations
Journal
Pain medicine
Abstract
Ketamine ( RS -2-[2-Chlorophenyl]-2-[methylamino] cyclohexanone) is a drug primarily used for anesthesia in human and veterinary medicine. It is predominately an N-methyl-d-aspartate (NMDA) receptor antagonist [1], but also at high dose has monoamine, muscarinic, mu 2 opioid, and voltage-gated calcium effects [2]. S-ketamine is the more physiologically active enantiomer. It has been formulated for oral, parenteral (SQ, IM, and IV), topical, intranasal, intrathecal, and IR use. It has a range of reported effects in humans including “dissociative” anesthesia, analgesia, hallucinations, elevated blood pressure (as opposed to most anesthetics), and bronchodilitation. It is commonly used in the initiation and maintenance of general anesthesia, and is now more frequently used in intensive care, emergency medicine, battlefield medicine, migraine, treatment of certain psychiatric conditions, and pediatric procedures. It is a popular drug of abuse. As it becomes clear that NMDA receptors are participant in central sensitization, at least in the dorsal horn [3], the search for a safe, tolerable, and effective NMDA antagonist has become a holy grail for the pharmaceutical industry. Until that compound is identified and vetted, ketamine is the best NMDA antagonist drug that we have. Unfortunately, there is little compelling evidence that ketamine is safe, tolerated, and/or effective in chronic pain conditions. Nonetheless, increasingly it is used clinically in the absence of such evidence. If ketamine were a new approach in chronic pain, the lack of evidence would be understandable; that is not the case. Ketamine was …