The diverse effects of ketamine, jack-of-all-trades: a narrative review.

Ketamine, discovered in 1962, acts as an NMDA receptor antagonist and provides dose-dependent anaesthetic, sedative, and analgesic effects. It also influences other cellular targets, yielding potential benefits including cardiovascular stability during sedation, analgesia for acute and chronic pain, bronchodilation in severe refractory asthma, anti-inflammatory properties especially in sepsis, tumour inhibition, and antidepressant effects that can reverse suicidal ideation. Reluctance to use ketamine clinically stems from stigma around its side-effects and abuse potential. This review surveys ketamine's diverse therapeutic potentials across fields and identifies areas for future research, such as perioperative medicine, pain management, ICU sedation, and tumour suppression during cancer surgery.

Study at a glance

Abstract

Ketamine, an N-methyl-D-aspartic acid receptor antagonist that was first discovered in 1962, has become established in anaesthesia providing dose-dependent anaesthetic, sedative, and analgesic effects. Ketamine, however, also acts on a wide range of other cellular targets, resulting in interesting and diverse effects on both physiological and pathological processes. Potential beneficial properties of ketamine include cardiovascular stability for patients undergoing sedation or anaesthesia, analgesia in both acute and chronic pain, bronchodilation in severe refractory asthma, anti-inflammatory properties particularly in sepsis, tumour inhibition, and antidepressant properties with marked ability to reverse suicidal ideation. The reluctance to adopt ketamine into routine practice is likely attributable in part to the stigma and negative reputation associated with its perceived side-effects and potential for abuse. This review explores the diverse properties and therapeutic potentials of ketamine being investigated across different fields whilst also identifying areas for ongoing and future research. Given the diverse range of potential benefits and promising early work, ketamine should be the focus of ongoing research in multiple different specialty areas. This includes areas relevant to anaesthesia and perioperative medicine, such as acute and chronic pain management, ICU sedation, and even tumour suppression in those undergoing surgical resection of malignancies.