Luft Ana, Mendes Florentino Fernandes
Serviço de Anestesiologia na Santa Casa de Porto Alegre, Porto Alegre, RS.
Rev Bras Anestesiol. 2005 Aug;55(4):460-9. doi: 10.1590/s0034-70942005000400011.
Low doses of ketamine or isomers are promising possibilities for anesthesia and postoperative analgesia. This study aimed at reviewing major properties of low ketamine doses, which may justify their use in anesthesia and postoperative analgesia.
Literature suggests that ketamine induces preemptive and preventive postoperative pain relief, decreasing opioid consumption and improving patients' satisfaction. Opioid-induced tolerance and hyperalgesia may be minimized with low ketamine doses. Ketamine decreases inhalational anesthetic consumption and may protect ischemic nervous cells. Promising effects, such as neuroprotection and improvement of long-term outcomes, require further studies.
Most studies with low S(+) ketamine doses have shown preventive effects, decreasing central nervous system sensitization, opioid-induced tolerance and hyperalgesia, anesthetic and analgesic consumption, and the incidence of postoperative adverse effects.
低剂量氯胺酮或其异构体有望用于麻醉和术后镇痛。本研究旨在综述低剂量氯胺酮的主要特性，这些特性可能证明其在麻醉和术后镇痛中的应用合理性。
文献表明，氯胺酮可诱导超前性和预防性术后疼痛缓解，减少阿片类药物用量并提高患者满意度。低剂量氯胺酮可将阿片类药物引起的耐受性和痛觉过敏降至最低。氯胺酮可减少吸入性麻醉药用量，并可能保护缺血性神经细胞。诸如神经保护和改善长期预后等有前景的作用尚需进一步研究。
大多数关于低剂量S(+)氯胺酮的研究已显示出预防作用，可降低中枢神经系统致敏、阿片类药物引起的耐受性和痛觉过敏、麻醉和镇痛药物用量以及术后不良反应的发生率。
