S(+)-ketamine

Abstract

SummaryS(+)-ketamine, the pure dextrorotatory enantiomer of ketamine has been available for clinical use in analgesia and anesthesia for more than 25 years. The main effects are mediated by non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor but S(+)-ketamine also interacts with opioid receptors, monoamine receptors, adenosine receptors and other purinergic receptors. Effects on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, metabotropic glutamate receptors (mGluR) and L‑type calcium chanels have also been described. S(+)-ketamine stimulates the sympathetic nerve system, making it an ideal drug for analgosedation or induction of anesthesia in instable patients. In addition, the neuroprotective properties, bronchodilatory, antihyperalgesic or antiepileptic effects provide interesting therapeutic options. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care.

Optimum Dose of Spinal Ropivacaine with or Without Single Intravenous Bolus of S-Ketamine During Elective Cesarean Delivery: A Randomized, Sequential Dose-Finding Study

“…The main effects of S-ketamine are mediated by non-competitive inhibition of the N-methyl-D-aspartate receptor; the compound also interacts with opioid receptors, monoamine receptors, and adenosine receptors. 22 It is associated with dissociation (ability to communicate with the patient is retained to a certain degree), quick onset, absence of breathing function depression, and circulatory stability in shock patients, making it popular among emergency and intensive care medicine practitioners. 22 In addition, it is relatively safe for infants and children, 13 making S-ketamine a suitable candidate for an adjuvant IV drug during cesarean delivery with spinal anesthesia.…”

“…22 It is associated with dissociation (ability to communicate with the patient is retained to a certain degree), quick onset, absence of breathing function depression, and circulatory stability in shock patients, making it popular among emergency and intensive care medicine practitioners. 22 In addition, it is relatively safe for infants and children, 13 making S-ketamine a suitable candidate for an adjuvant IV drug during cesarean delivery with spinal anesthesia. The present study ndings suggest that an ultra-low single IV bolus dose of S-ketamine may induce sleep, decrease visceral traction pain from surgical interventions, and eliminate tension in patients that undergo cesarean delivery without increasing the risk of adverse events.…”

“…Moreover, patients undergoing elective cesarean delivery without gastroesophageal re ux or full stomach were included in this study; thus, neither re ux nor aspiration were observed in any of the study patients. Although the coughing, gag, and swallowing re exes remained functional after the administration of S-ketamine, 22 the use of S-ketamine in patients with full stomach or gastroesophageal re ux disease is unsuitable. Finally, the rst contact between mother and neonate is important, promoting parent-child bonding and mother's willingness to breast-feed.…”

Inner privacy of conscious experiences and quantum information

“…Many patients have their eyes open, exhibit spontaneous movements, and retain functional reflexes. Tears and saliva may also flow but the patient does not remember the operation or the anesthesia [66]. The emergence from anesthesia itself may be associated with unpleasant dreams and hallucinations.…”

S-ketamine alleviates carbon tetrachloride-induced hepatic injury and oxidative stress by targeting the Nrf2/HO-1 signaling pathway

“…S-KET is an isomer of KET with superior efficacy and controllability, and fewer side effects as compared to a racemic mixture of R-KET and S-KET (Kose et al, 2012;Paul et al, 2009;Trimmel et al, 2018). In recent years, S-KET has been widely used in Europe and the United States for the treatment for mental health disorders (Wilkinson et al, 2018;Bartlett et al, 2020;Grunebaum et al, 2018;Murrough et al, 2015), post-traumatic stress disorder, and related syndromes, while racemic ketamine is still widely used in China (Chang et al, 2019;Aleksandrova et al, 2017;Zanos and Gould, 2018;du Jardin et al, 2016).…”