Ketamine

Lore & Background

It has been regularly used in veterinary medicine and was extensively used for surgical anesthesia in the Vietnam War. At anesthetic doses, ketamine induces a state of dissociative anesthesia, providing pain relief, sedation, and amnesia while preserving breathing and airway reflexes, stimulating heart function, and causing moderate bronchodilation. It is used especially in trauma, emergency, and pediatric cases. At lower, sub-anesthetic doses, it is used as a treatment for pain and treatment-resistant depression. Racemic ketamine, especially at higher doses, may be more effective and longer-lasting than esketamine in reducing depression severity.

Reader's Guide

Ketamine's significance lies in its unique pharmacological profile as an NMDA receptor antagonist that provides dissociative anesthesia with minimal respiratory depression, making it valuable in emergency and field settings such as the Vietnam War. The drug is tightly controlled due to recreational use for its hallucinogenic and dissociative effects, with long-term effects of repeated use largely unknown and under active investigation. Liver and urinary toxicity have been reported among regular recreational users. Ketamine is contraindicated in severe heart or liver disease and uncontrolled psychosis. Its clinical and antidepressant effects can be influenced by co-administration of other drugs, though these interactions are variable and not yet fully understood.

Did You Know?

• It was extensively used for surgical anesthesia in the Vietnam War.