Since 1970, ketamine has been used in hospitals. It is a one-of-a-kind IV anesthetic with a wide range of pharmacological effects, including sedation, catalepsy, somatic analgesia, bronchodilation, and sympathetic nervous system stimulation. Ketamine is less commonly used by anesthesiologists today because there are newer drugs available, its side effects are frightening, it has a bad reputation as a “vet medicine,” and it is becoming more well-known as a drug that can be abused. However, ketamine has withstood the test of time due to its distinct properties and novel clinical applications. It is still used in medicine in a variety of ways. Most modern anesthesiologists do not receive extensive training in the use of ketamine. They are unaware that ketamine can be used in a variety of medical applications. With this in mind, a comprehensive review of the literature was conducted using the electronic databases PubMed and Cochrane. A large number of books and journals on anesthesia were examined. Based on this, this review article discusses the current applications of ketamine in anesthesia, pain management, and critical care.
PHARMACOLOGY OF KETAMINE IN BRIEF
Fundamental chemistry
Ketamine is a water-soluble form of phencyclidine. Ketamine molecules have an asymmetric carbon atom with two isomers known as S(+) and R(-).
Pharmacodynamics
Ketamine stimulates the cardiovascular system, causing an increase in heart rate, blood pressure, and cardiac output through the sympathetic nervous system. It has little effect on central respiratory drive and relaxes the airways by acting on a variety of receptors, inflammatory cascades, and bronchial smooth muscles. It raises the rate of salivation and muscle tone. The cataleptic state is characterized by a loss of orthostatic reflexes but not by impaired consciousness. Ketamine causes a dissociative state in which the patient appears to be awake but is disconnected from his or her surroundings while keeping the eyes open.
Pharmacokinetics
Ketamine is highly lipid soluble, meaning it degrades quickly and is distributed equally to peripheral tissues. In the liver, it is extensively metabolized via the N-demethylation and ring hydroxylation pathways. The main metabolite is norketamine, which has one-third to one-fifth the anesthetic potency of ketamine. Ketamine is excreted in the urine and faeces as norketamine and hydroxylated derivatives. It has a multiplicative effect. Resistance gradually builds up with repeated administration.
Action mechanism
It primarily works by antagonizing the N-methyl D-aspartic acid (NMDA) receptor in a noncompetitive manner. It also has anesthetic properties and interacts with opioid receptors, monoamine receptors, cholinergic, purinergic, and adrenoceptor systems.
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