Abdollahpour Abolfazl, Saffarieh Elham, Zoroufchi Babak Hosseinzadeh
Department of Anesthesiology, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran.
Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran.
J Family Med Prim Care. 2020 Mar 26;9(3):1317-1324. doi: 10.4103/jfmpc.jfmpc_875_19. eCollection 2020 Mar.
Ketamine is considered as a promising drug for many clinical applications even after five decades since its discovery. Ketamine is a dissociative anesthetic agent with a variety of pharmacological effects from anesthetic induction and maintenance to analgesic and sedative depending on the consuming dose. It can be used solely or in combination with other co-adjuvant drugs, increasing their efficacy. Many therapeutic properties of ketamine have been attributed to its antagonism mechanism to N-Methyl-D-aspartate receptor. Identifying new properties of ketamine such as neuroprotective, antiinflammatory, and antitumor effects, on one hand, and taking advantage of subanesthetic regimens of ketamine, on the other hand, have resulted in a widespread use of ketamine in various clinical applications. Ketamine is solvable in aqueous and lipid solutions, providing convenient administration via multiple routes, including oral, nasal, rectal, intravenous, intramuscular, subcutaneous, transdermal, sublingual, and intraosseous administration. Application of ketamine has some advantages over other sedative and anesthetic agents. It produces bronchodilation status, allowing for most secure induction of anesthesia in patients with life-threatening asthma and intense acute bronchial constriction. Ketamine has an excellent hemodynamic profile, makes it the agent of choice for patients with unstable hemodynamics, such as shocked or hypotensive patients. Ketamine usage has been associated with a lower risk of respiratory depression and relatively more conserved airway reflexes. Although being an anesthetic agent, ketamine has been increasingly used in subanesthetic doses for acute and chronic pain as well as depression. Using ketamine in pre and postoperative pain management is well established. However, the studies on ketamine performance in pain management demonstrated contradicting results. On the other hand, various side effects along with no confirmatory data on long-term treatment demand great caution when using ketamine for treating complex chronic pains. The present study aimed to provide a general review on the recent applications of ketamine in anesthesia, pain management, and critical care.
自氯胺酮被发现以来的五十年间，它一直被认为是一种在许多临床应用中颇具前景的药物。氯胺酮是一种解离性麻醉剂，根据用药剂量不同，具有从麻醉诱导、维持到镇痛和镇静等多种药理作用。它可单独使用或与其他辅助药物联合使用，从而提高其疗效。氯胺酮的许多治疗特性归因于其对N-甲基-D-天冬氨酸受体的拮抗机制。一方面，确定氯胺酮的新特性，如神经保护、抗炎和抗肿瘤作用；另一方面，利用氯胺酮的亚麻醉方案，导致氯胺酮在各种临床应用中得到广泛使用。氯胺酮可溶于水性和脂质溶液，便于通过多种途径给药，包括口服、鼻内、直肠、静脉内、肌内、皮下、经皮、舌下和骨内给药。氯胺酮的应用相对于其他镇静和麻醉剂具有一些优势。它能产生支气管扩张状态，使在患有危及生命的哮喘和严重急性支气管痉挛的患者中进行最安全的麻醉诱导成为可能。氯胺酮具有出色的血流动力学特征，使其成为血流动力学不稳定患者（如休克或低血压患者）的首选药物。氯胺酮的使用与较低的呼吸抑制风险和相对更保留的气道反射相关。尽管氯胺酮是一种麻醉剂，但它已越来越多地以亚麻醉剂量用于急性和慢性疼痛以及抑郁症的治疗。氯胺酮在术前和术后疼痛管理中的应用已得到充分证实。然而，关于氯胺酮在疼痛管理中表现的研究结果相互矛盾。另一方面，各种副作用以及缺乏关于长期治疗的确切数据，使得在使用氯胺酮治疗复杂慢性疼痛时需要格外谨慎。本研究旨在对氯胺酮在麻醉、疼痛管理和重症监护中的最新应用进行全面综述。
