Ketamine: a growing global health-care need

Abstract

Belgium in 1963, and approved for human use by the US Food and Drug Administration in 1970. Unlike inhalation anaesthetics, ketamine provides analgesia, preserves airway reflexes, offers haemodynamic stability, and maintains respiratory drive, which gives ketamine an excellent safety profile. It is therefore a favoured choice for trauma triage, use in man-made and natural disasters, and for many other patients with compromized haemodynamic stability. However, side-effects, such as agitation, hallucinations, and panic attacks, have limited its clinical use as an anaesthetic in affluent countries. Lately, ketamine has found new uses in clinical medicine in addition to renewed threats to its availability. Ketamine has long had a place in the management of acute pain via intraoperative low-dose infusion, especially in opioidtolerant patients, and has likewise been used after surgery with minimal psychomimetic effects. 1 With a growing number of patients diagnosed with chronic pain and only 30-40% of patients achieving adequate to good pain relief, anaesthetists and pain specialists have now looked to ketamine to treat chronic pain syndromes. 2 Activation of N-methyl--aspartate (NMDA) receptors plays a role in central sensitization, wind-up phenomenon, and opioid tolerance. The NMDA receptor is an excitatory glutamate receptor present at spinal and supraspinal sites. In chronic

Access to controlled medicines for anesthesia and surgical care in low-income countries: a narrative review of international drug control systems and policies

“…The estimates that do exist, however, suggest that surgical conditions (including common conditions such as trauma, malignancies, congenital anomalies, complications of pregnancy, cataracts, and perinatal conditions) comprise 11-32% of the global burden of disease. [4][5][6] These data show that the low volume of surgical procedures performed in lowincome countries does not correspond to the need. Rather, a significant gap in access to surgery exists, with over 5 billion people lacking access to safe and affordable surgical and anesthesia care.…”

“…Attempts to quantify these gaps have revealed an anesthesia workforce that is up to a hundred times smaller per capita in low-income vs high-income countries, with grossly insufficient access to basic equipment such as pulse oximetry and anesthetic medicines. [5][6][7][8] For a better understanding of the reasons for this gap in global surgery, we examined one of the likely drivers of poor access to anesthesia care, i.e., access to controlled medicines. Many commonly used anesthesia medicines, such as potent analgesics, hypnotics, and others, are essential to the provision of anesthesia and perioperative care and pain management.…”

Effect of intravenous S-ketamine on the MAC of sevoflurane: a randomised, placebo-controlled, double-blinded clinical trial

“…Ketamine is also used in outpatient units for those suffering from chronic pain or depression. 1 The main action of ketamine is non-competitive antagonism at N-methyl-D-aspartate (NMDA) receptors. NMDA receptors modulate nociception and are involved in the development of chronic pain syndromes.…”

Safe Anaesthesia in Remote Sites

“…ketamine, ventilating the patients with ambient air delivered by an ambu bag [21]. The current tendency to restrict the use of ketamine [22] is a serious harm for these patients. Figure 1 shows one of those remote sites where anaesthesia is practiced as safe as possible with the limited resources available.…”