Ketamine Use for Palliative Care in the Austere Environment: Is Ketamine the Path Forward for Palliative Care.
The American journal of hospice & palliative care – March 01, 2025
Source: PubMed
Summary
In combat zones and remote environments, managing severe pain and providing comfort to critically wounded patients presents unique challenges. Ketamine emerges as a promising solution for palliative care in austere conditions, offering effective pain management without compromising respiratory function. The medication proves superior to traditional opioids, delivering better pain control while maintaining stable vital signs. Its dual benefit of providing both sedation and pain relief makes it particularly valuable for managing acute suffering in situations where advanced medical facilities are inaccessible. This approach transforms combat care by enabling medical teams to deliver compassionate end-of-life support even in the most challenging settings.
Abstract
The goal of palliative care is to focus on the holistic needs of the patient and their family versus the pathology of the patient's diagnosis to reduce the stress of illness. U.S. servicemembers deployed to austere environments worldwide have significantly less access to palliative care than in military treatment facilities in the U.S. Preparation for future conflicts introduces the concept of prolonged medical management for an environment where urgent casualty evacuation is impossible. Ketamine is currently widely used for analgesia and anesthesia in the care of military service members and its use has increased in combat zones of Iraq and Afghanistan due to the favorable preservation of respiratory function, minimal changes in hemodynamics, and lower pain scores compared to opioids. Ketamine acts as a non-competitive antagonist on N-methyl-D aspartate (NMDA) receptors. Its anesthesia and analgesic effects are complex and include both presynaptic and postsynaptic neurons in brain and spinal cord. The use of palliative care to minimize suffering should not be withheld due to the logistical boundaries of austere military environments or lack of guidelines for recommended use. The use of ketamine for palliative care is a new clinical management strategy to provide both sedation and pain management for an acute pain crisis or comfort measures for the terminally ill. This makes ketamine an attractive consideration for palliative care when managing critically wounded patients for an extended time.