Hersack R A
Department of Anesthesia, Wilford Hall Medical Center, Lackland AFB, TX.
Aviat Space Environ Med. 1994 Nov;65(11):1041-6.
Since ketamine was approved for clinical use, there has been debate over whether the psychological effects of ketamine warrant avoiding use of the drug in patients based on their occupation. This article reviews the literature to determine if such concerns are valid. After 25 years of clinical experience with ketamine, fewer than 10 cases document the occurrence of delayed psychological effects potentially attributable to that drug. In most cases, the delayed effects were temporary, resolving within 3 weeks. Further, there were no long-term psychological effects clearly attributable to ketamine. Children who manifested delayed effects had several other factors present placing them at risk for long-term psychological changes independent of their receiving ketamine. Several controlled studies investigating the risk of long-term psychological effects due to ketamine fail to document that the risk of permanent psychological changes from ketamine is any greater than that from any other anesthetic. In conclusion, there is no evidence in the literature that ketamine presents a higher risk compared to other anesthetics for causing long-term psychological effects that result in a patient not being able to return to his or her occupation. The decision of whether to use ketamine should be a clinical decision weighing relative risks versus benefits, and not a decision based on the patient's career.
自氯胺酮被批准用于临床以来，关于氯胺酮的心理效应是否足以使基于患者职业的原因而避免使用该药物一直存在争议。本文回顾文献以确定此类担忧是否合理。在有25年氯胺酮临床经验之后，记录在案的可能归因于该药物的延迟性心理效应病例少于10例。在大多数情况下，延迟效应是暂时的，在3周内消退。此外，没有明确归因于氯胺酮的长期心理效应。出现延迟效应的儿童还有其他几个因素，使他们有独立于接受氯胺酮之外的长期心理变化风险。几项研究氯胺酮导致长期心理效应风险的对照研究未能证明氯胺酮导致永久性心理变化的风险比任何其他麻醉剂更大。总之，文献中没有证据表明与其他麻醉剂相比，氯胺酮在导致长期心理效应从而使患者无法重返工作岗位方面具有更高风险。是否使用氯胺酮的决定应该是权衡相对风险与益处的临床决定，而不是基于患者职业的决定。
