From the Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada.
Anesth Analg. 2017 Apr;124(4):1237-1243. doi: 10.1213/ANE.0000000000001856.
Neurologic deterioration following acute injury to the central nervous system may be amenable to pharmacologic intervention, although, to date, no such therapy exists. Ketamine is an anesthetic and analgesic emerging as a novel therapy for a number of clinical entities in recent years, including refractory pain, depression, and drug-induced hyperalgesia due to newly discovered mechanisms of action and new application of its known pharmacodynamics. In this focused review, the evidence for ketamine as a neuroprotective agent in stroke, neurotrauma, subarachnoid hemorrhage, and status epilepticus is highlighted, with a focus on its applications for excitotoxicity, neuroinflammation, and neuronal hyperexcitability. Preclinical modeling and clinical applications are discussed.
急性中枢神经系统损伤后神经功能恶化可能可以通过药物干预来治疗,尽管迄今为止还没有这样的治疗方法。氯胺酮是一种麻醉剂和镇痛药,近年来因其新的作用机制和已知药效学的新应用而成为治疗多种临床疾病的新疗法,包括难治性疼痛、抑郁和药物引起的痛觉过敏。在本次重点综述中,重点介绍了氯胺酮作为脑卒中、神经创伤、蛛网膜下腔出血和癫痫持续状态的神经保护剂的证据,重点介绍了其在兴奋性毒性、神经炎症和神经元过度兴奋中的应用。讨论了临床前模型和临床应用。