A review on the recent application of ketamine in the management of anesthesia, pain, and health care total information in 2020

Abstract

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 the N-Methyl-D-aspartate receptor. Identifying new properties of ketamine such as neuroprotective, anti-inflammatory, 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. The application of ketamine has some advantages over other sedative and anesthetic agents. It produces bronchodilation status, allowing for the most secure induction of anesthesia in patients with life-threatening asthma and intense acute bronchial constriction. Ketamine online has an excellent hemodynamic profile, making 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 of the recent applications of Ketamine liquid supplier in anesthesia, pain management, and critical care.

Introduction

The unique properties of ketamine and its large versatility make it suitable to be used in prehospital medicine and emergency situations, and anesthetists and their assistants benefit its unique properties all over the world. Ketamine satisfies many requirements of an ideal opioid alternative, including strong analgesia, proper hemodynamic profile, very little inherent respiratory depression, and governable adverse effects. As a dissociative anesthetic, ketamine provides deep analgesia with amnesia. Compared to other anesthetic agents, ketamine usage results in a lower risk of respiratory depression and relatively more conserved airway reflexes. Currently, using ketamine for anesthesia is limited due to factors such as incidence of various side effects (e.g. excitation, illusion, and panic attacks), the availability of new alternatives, its disturbing emergence reactions, and the potential to be abused by individuals. For example, the application of ketamine in perioperative pain management is more common than using it as an induction agent of general anesthesia. Using ketamine as an anesthetic has been reported to be beneficial in certain cases such as in the prehospital setting, in trauma patients with hemodynamic compromise, in military services for wounded troops, and for children requiring sedation for painful or frightening procedures in the Emergency Department.

Despite the great potential of ketamine in pain management, its various treatment regimens lead to concerns regarding adverse effects. The adverse effects of ketamine vary based on the administered dose, and a range of the side effects has been related to using high doses of ketamine. Despite the importance of prescription dose levels of ketamine in the occurrence of the side effects, there is no general consensus on dose or administration regimen. The aim of the present study is to provide an overview of recent literature on the various applications of ketamine and its benefits and risks for patients in various clinical settings. It also summarizes the proposed doses of ketamine for many clinical settings.