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Ketamine, initially developed as an anesthetic, has shown versatility in medical applications, including pain management, treatment-resistant depression, and sedation in the intensive care unit (ICU). While generally well-tolerated, long-term use at high doses raises concerns about potential toxicities, particularly in the liver. We present a case of a 27-year-old female with a complex medical history who received ketamine infusion for ICU sedation and experienced a sudden rise in liver function tests (LFTs), indicating possible ketamine-induced liver injury (KILI). The patient’s liver function normalized after ketamine discontinuation. KILI is infrequent with short-term ketamine use, but emerging case reports suggest it may be associated with chronic or intermittent exposure. The underlying mechanisms for KILI are not fully understood but may involve the accumulation of ketamine metabolites, causing direct toxic effects on the liver. As ketamine’s use expands, especially in critical care settings, clinicians should be vigilant for the potential development of KILI. Further research is needed to better understand its risk factors and mechanisms, as early detection and management of KILI are crucial to ensuring patient safety and optimizing ketamine’s therapeutic benefits.
Ketamine, initially developed as an anesthetic, has shown versatility in medical applications, including pain management, treatment-resistant depression, and sedation in the intensive care unit (ICU). While generally well-tolerated, long-term use at high doses raises concerns about potential toxicities, particularly in the liver. We present a case of a 27-year-old female with a complex medical history who received ketamine infusion for ICU sedation and experienced a sudden rise in liver function tests (LFTs), indicating possible ketamine-induced liver injury (KILI). The patient’s liver function normalized after ketamine discontinuation. KILI is infrequent with short-term ketamine use, but emerging case reports suggest it may be associated with chronic or intermittent exposure. The underlying mechanisms for KILI are not fully understood but may involve the accumulation of ketamine metabolites, causing direct toxic effects on the liver. As ketamine’s use expands, especially in critical care settings, clinicians should be vigilant for the potential development of KILI. Further research is needed to better understand its risk factors and mechanisms, as early detection and management of KILI are crucial to ensuring patient safety and optimizing ketamine’s therapeutic benefits.
Introdução: A cetamina é um anestésico dissociativo que tem ganhado destaque devido aos seus potenciais benefícios em pacientes críticos, incluindo efeitos analgésicos, preservação da função cardiovascular, e neuroproteção. Este estudo tem como objetivo revisar de forma sistemática e realizar uma meta-análise dos estudos que investigam o uso de cetamina em pacientes críticos. Métodos: Foi realizada uma busca sistemática nas bases de dados PubMed, Scopus e Cochrane Library, utilizando os termos "ketamine", "critical care", "intensive care", "analgesia", "sedation", "neuroprotection" e suas combinações. Foram incluídos ensaios clínicos randomizados e estudos observacionais que avaliaram o uso de cetamina em pacientes adultos e pediátricos em unidades de terapia intensiva. Resultados e Discussão: A cetamina apresenta potencial como um adjuvante eficaz no manejo de pacientes críticos. A redução observada na necessidade de opioides e o melhor controle da dor são particularmente significativos, visto que complicações relacionadas a opioides continuam sendo uma preocupação em ambientes de terapia intensiva. Além disso, a menor incidência de delirium associada ao uso de cetamina é importante, considerando os efeitos prejudiciais do delirium nos resultados dos pacientes. A cetamina foi associada a uma redução significativa na necessidade de sedativos opioides, melhor controle da dor e menor incidência de delirium em pacientes críticos. Além disso, não houve evidências consistentes de efeitos adversos graves relacionados ao uso de cetamina. Conclusões: O uso de cetamina em pacientes críticos parece ser seguro e eficaz, oferecendo benefícios significativos na analgesia, sedação e prevenção de delirium. No entanto, são necessários mais estudos para definir diretrizes claras de uso e determinar o impacto de longo prazo da cetamina na função orgânica e na sobrevida desses pacientes.
Objectives: Ketamine has a fast onset of action that may offer a paradigm change for depression management at the end of life. We aimed to synthesize evidence regarding the safety and efficacy of ketamine in depression treatment within a broad palliative care concept. Methods: We searched seven databases and included studies on the safety and efficacy of ketamine for depression treatment in patients diagnosed with any life-threatening disease. We also conducted a narrative review of the evidence. Results: Among 2,252 screened titles and abstracts, we included 32 studies in our final synthesis: 14 case reports, two case series, two quasi-experimental studies, and seven randomized clinical trials (RCTs), as well as data from three unpublished clinical trials and seven cases from four larger case series. Most case reports reported a robust effect; however, the larger studies reported conflicting findings. Five RCTs reported positive outcomes; however, four of them were focused on a perioperative setting. Two negative studies did not primarily focus on depression and did not apply severity cutoffs. Conclusion: Although ketamine is generally safe and potentially useful, its efficacy in palliative care settings remains unclear. It may be a reasonable alternative for perioperative depression in oncological patients.
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