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Ketamine is a medication primarily used for starting and maintaining anesthesia. It induces dissociative anesthesia, a trance-like state providing pain relief, sedation, and amnesia.
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The distinguishing features of ketamine anesthesia are preserved breathing and airway reflexes, stimulated heart function with increased blood pressure, and moderate bronchodilation.At lower, sub-anesthetic doses, ketamine is a promising agent for pain and treatment-resistant depression.However, the antidepressant action of a single administration of ketamine wanes with time, and the effects of repeated use have not been sufficiently studied.
Psychiatric side effects are frequent as well as raised blood pressure and nausea. Liver and urinary toxicity are common among regular users of high doses of ketamine for recreational purposes. Ketamine is an NMDA receptor antagonist, and that accounts for most of its actions except the antidepressive effect, the mechanism of which is a matter of much research and debate.
Ketamine was discovered in 1956 and approved for use in the United States in 1970. It was extensively used for surgical anesthesi
The use of ketamine in anesthesia reflects its characteristics. It is a drug of choice for short-term procedures when the muscle relaxation is not required.The effect of ketamine on the respiratory and circulatory systems is different from that of other anesthetics. It suppresses breathing much less than most other available anesthetics.When used at anesthetic doses, ketamine usually stimulates rather than depresses the circulatory system.Protective airway reflexes are preserved,and it is sometimes possible to administer ketamine anesthesia without protective measures to the airways.Psychotomimetic effects limit the acceptance of ketamine; however, they can be counteracted by administering benzodiazepines or propofol.
Ketamine is frequently used in severely injured people and appears to be safe in this group. It has been widely used for emergency surgery in field conditions in war zones,A 2011 clinical practice guideline supports the use of ketamine as a sedative in emergency medicine, including during physically painful procedures.It is the drug of choice for people in traumatic shock who are at risk of hypotension. Low blood pressure is harmful in people with severe head injury, and ketamine is least likely to cause low blood pressure and often even able to prevent it.
Ketamine is an option in children, as the sole anesthetic for minor procedures or as an induction agent followed by neuromuscular blocker and tracheal intubation In particular, children with cyanotic heart disease and neuromuscular disorders are good candidates for ketamine anesthesia.
Due to the bronchodilating properties of ketamine, it can be used for anesthesia in people with asthma, chronic obstructive airway disease, and with severe reactive airway disease including active bronchospasm.
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