Editorials

Ketamine: a misunderstood analgesic?

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7556.1466 (Published 22 June 2006) Cite this as: BMJ 2006;332:1466
  1. Nosa A Akporehwe, senior specialist registrar in neurological rehabilitation (nosa.akporehwe@nap.nhs.uk),
  2. Paul R Wilkinson, consultant in anaesthesia and pain management,
  3. Rachel Quibell, specialist registrar in palliative care,
  4. Kerstin A Akporehwe, general practitioner
  1. Hunters Moor Regional Neurological Rehabilitation Centre, Newcastle upon Tyne NE 2 4NR
  2. Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  3. Marie Curie Hospice, Newcastle upon Tyne NE4 6SS
  4. Mountbatten Medical Centre, Hebburn NE31 1LD

    Clinicians shouldn't be put off by its reputation as an anaesthetic and drug of abuse

    Ketamine is well known as an intravenous anaesthetic agent with analgesic properties. It is also becoming well known as a drug of abuse. Less well known, however, is the fact that oral ketamine is a useful analgesic agent in cancer and chronic non-malignant pain. Indeed, its reputation as a drug of abuse may be making clinicians overcautious about its use for pain relief.

    In anaesthetic practice high plasma and brain concentrations of ketamine result in dissociative anaesthesia, amnesia, a rise in arterial pressure, increased heart rate and cardiac output, and raised intracranial pressure with relative preservation of airway reflexes and respiration. Ketamine became established for use in hypovolaemic patients and in difficult locations such as battlefields because of its safety. Reports have also suggested relatively few serious adverse effects using …

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