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Ketamine is a prescription drug and a controlled substance, primarily used as a rapid-onset, short-acting pain-killing agent (anesthetic) during acute and emergency surgical procedures. Unlike other anesthetics drugs, Ketamine is less likely to cause breathing suppression, making it the drug of choice when reliable respiratory ventilating apparatus is not available. Ketamine infusions involve the release of Ketamine directly into the bloodstream.
Ketamine was initially developed in 1963 as a veterinary anesthetic. Its promising results in animals triggered clinical trial in human prisoners, and led to a conclusion that it is as effective as it was in animals.
Ketamine is an effective pain-killer after a surgical procedure, if co-administered with a low-dose opioid drug (such as morphine). Ketamine infusions have shown effective control of acute pain, neuropathic pain (pain caused by decrease in blood supply in one area of the body), pain caused by cancer, and complex regional pain syndrome. Ketamine infusions are also being used in the treatment of bipolar depression, major depression, and for people with suicidal ideation.
Ketamine is known as a “dissociative anesthetic”, which means that this drug can induce general anesthesia (though when induced, the patient remains awake), catatonia (loss of control over voluntary movement), and transient amnesia (loss of memory). Ketamine can distort perception of sight and sound (auditory and visual hallucinations) and produces feeling of detachment from one’s self and the environment. Because of this, Ketamine has been placed on the list of controlled substances in the US because of its tendency to be used for recreation and potential for substance abuse. Ketamine can cause death in high, unsupervised doses.
Ketamine infussions are used to treat therapy-resistant chronic pain syndromes. Blonk et al , through the European Journal of Pain, published an article about the “Use of Oral Ketamine in Chronic Pain Management.” They listed all available clinical data regarding the use of Ketamine Infusions in the therapeutic management of chronic pain in several disease conditions.
These include the following:
Ketamine may cause common and even serious side effects, depending on the dosage consumed, some of which do not require immediate medical attention.
The most common side effects of the use of Ketamine are:
A physician may consider ketamine infusions for therapy under certain conditions: In addition to being known anesthetic and analgesic medication, ketamine has been used off-label in the medical community when conventional treatment for chronic/acute and neuropathic pain fails to mitigate the pathological symptoms and condition; Moreover, it has exponentially increased interest and implication in clinical treatment for depression, obsessive-compulsive disorder, bipolar disorder, post traumatic stress disorder and other select psychiatric conditions that fail to demonstrate positive improvement in symptoms.
Ketamine infusions may be given within or outside the hospital setting. We specialize in the outside hospital setting, where patients are given 70mg to maximum of 200mg daily for 10 days in tapered doses. Fatigue may also occur, but there are no reported long term side effects for outpatient ketamine administration.
Several techniques are being used to measure efficacy of ketamine treatment. Pain and depression are both subjective phenomenon, and a qualitative and objective instrument must be used in order to assess therapeutic efficacy. The following are some of the pain scoring systems and depression evaluation methods that are routinely being used: Pain assessment scales Visual Analog Scale (VAS) Wong-Baker FACES Pain Rating Scale 0–10 Numeric Pain Rating Scale Pain Quality Assessment Scale Relief of depression Beck Depression Inventory (BDI) Montgomery-Asberg Depression Rating Scale (MADRS) Zung Self-Rating Depression Scale Hamilton Depression Rating Scale (HAM-D)
It is expected that patients who would receive ketamine infusion therapy would enjoy immediate pain relief and comfort that are not usually attained from traditional forms of pain treatment.
Ketamine’s rapid therapeutic effect also allows effective management of depression and obsessive-compulsive urges. This gives patients a more stable mood control and even save them from suicidal ideation.
Outcomes of both conditions treated with Ketamine infusions ultimately allow patients to receive cost-efficient plan of care and achieve a better quality of life.