Ketamine Use for Palliative Care in the Austere Environment: Is Ketamine the Path Forward for Palliative Care.

Palliative care focuses on the holistic needs of patients and their families rather than on the pathology of a diagnosis, aiming to reduce the stress of illness. U.S. service members deployed to austere environments have significantly less access to such care than those in military treatment facilities in the U.S. Ketamine, widely used for analgesia and anesthesia in combat zones, preserves respiratory function, causes minimal hemodynamic changes, and yields lower pain scores compared to opioids. Its use for palliative care is a new clinical strategy to provide sedation and pain management for acute pain crises or comfort measures for the terminally ill, making it attractive for managing critically wounded patients during prolonged medical care when evacuation is impossible.

Study at a glance

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.