Title

Association of Ketamine with PTSD in the Perioperative Setting: A Literature Review

Document Type

Conference Proceeding

Publication Date

10-9-2021

Abstract

Ketamine is a drug commonly used in the perioperative period secondary to its favorable side effect profile. It offers dose related unconsciousness and “dissociative anesthesia” in addition to analgesia. Ketamine works as an antagonist at the N-methyl-D-aspartate (NMDA) receptors, inhibiting their activation by the excitatory neurotransmitter glutamate. Glutamate is the most abundant excitatory neurotransmitter in the brain, known for its involvement in psychiatric disorders including post-traumatic stress disorder (PTSD).

Ketamine is known to cause “dissociative amnesia” which is an unpleasant reaction that may include hallucinations, vivid dreams, extracorporeal experiences, and altered visual, tactile, and auditory sensitivity. Fear and confusion may be prominent during and shortly after emergence. Due to the unpleasant emergence reactions produced with intraoperative ketamine, it has been hypothesized that induction with ketamine has the potential to acutely aggravate PTSD symptomology and increase the risk of emergence delirium.

This review will summarize the relevant literature to determine an association between ketamine administration and increase in PTSD associated symptoms in those patients at risk. To date, studies investigating the association between ketamine and fear memory in rodent models have been inconsistent and variable depending on factors such as dose and route of administration. Although evidence suggests that subanesthetic doses of ketamine may be useful in the human treatment of several psychiatric disorders, there are gaps in the current literature about the perioperative effects of ketamine on patients who suffer from PTSD. Earlier published reports evaluating ketamine administration in the acute setting suggest an increase in acute stress disorder (ASD) and PTSD, although recent evidence argues against this relationship.Ketamine is receiving increased attention in recent literature due to the therapeutic role it may play in psychiatric disorders; however, little is known about the perioperative effects of ketamine administration on this patient population. Given the lack of publications evaluating intraoperative ketamine in patients with PTSD and the conflicting results presented in the literature, further research is needed to determine if a relationship exists between ketamine administration and acute PTSD symptomology.

Comments

American Society of Anesthesiology Annual Meeting, San Diego, CA, October 8-12, 2021.

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