Why Ketamine
What is Ketamine
Ketamine is a sedative that works on the NDMA receptor in neurons. The NMDA receptor has important functions in neural plasticity, neural regeneration, learning and memory. These are essential functions of the central nervous system (CNS) that are especially disrupted by psychiatric disorders, such as depression and anxiety. By acting on the NDMA receptor, ketamine resets the CNS, essentially allowing for a reboot. In addition, ketamine is one of the few sedatives that have pain modulation properties.
Why Ketamine
Obtaining relief for patients with chronic psychological and physical pain can be a daunting task. Such distress often severely limits a person’s daily functioning and creates a vicious cycle of continuous decline and suffering. The stress can be so severe that one is constantly reminded of pain in every second and desperately needs something to break the pain cycle.
Ketamine is a unique sedative with a dissociative property. It allows for a complete disengagement from one’s concurrent experience, breaking the cycles of ever-evolving pain as a result. It essentially resets one’s central nervous system, which has been held hostage by distress, so that its native neuroregenerative and neuroplastic capabilities are regained to heal the system. Among all sedatives, it also has one of the best safety profiles and is non-addictive.
What Is It Used For
Besides being a potent sedative, ketamine has historically been used for treating pain crises in sickle cell patients. These are patients who have pain so severe that it does not even resolve with the most potent narcotic doses, which are up to 10–100 times the standard dose. Ketamine resets the pain threshold in a very short timeframe. Many of these patients are specifically hospitalized for a few days for ketamine infusion and are able to return to their baseline activities after discharge. Research has extended its use to treat drug-resistant depression, anxiety, PTSD, postpartum depression, OCD and chronic pain. Ketamine infusion has become a life-altering therapy for many, and often it is the only thing that allows them to retain their daily functions.
How Is It Administered
Ketamine is given through an IV. It is a potent sedative that should only be administered by trained professionals in a controlled setting. It is given in incremental doses to maximize its potency and duration while minimizing its side effects. Infusion of ketamine must be monitored in real time by physicians well-versed in performing sedation.
How Safe Is It
Ketamine is one of the safest sedatives. Most sedatives cause severe respiratory depression that requires patients to be on a ventilator and a breathing tube. Inappropriate use is often lethal. Ketamine has minimal respiratory depressive effects and can be administered without additional invasive respiratory support. However, inappropriate use can still cause life-threatening hypoxia. As a result, ketamine is administered by physicians with expertise in sedation, such as anesthesiologists and ED and ICU doctors. These highly trained professionals routinely stabilize hyperacute medical catastrophes; managing the undesirable symptoms of ketamine infusion is a routine task for them.
Sometimes, the dissociative effect of ketamine can be overwhelming. This is easily mitigated by adding a tiny amount of an alternative sedative.
Lastly, ketamine augments the body’s sympathetic system and activates the “fight, fright or flight” response. Again, the physician in charge will manage the patient’s blood pressure and heart rate during infusion, making sure that vital signs are stable.
Other common but temporary side effects include anxiety, dizziness, headache, nausea and vomiting. These are usually very transient and easily reversible.