Non-analgesic effects of Ketamine hydrochloride. New applications

Abstract

Ketamine hydrochloride (CKTM) is a dissociative anesthetic agent, with a unique position in the anesthetic practice. It was first described in the literature in 1965 and approved by the Food and Drug Administration (FDA) in 1970, being introduced commercially with the manufacturers description as that of a "general anesthesia non-barbiturate of rapid action.” This drug is considered as the only complete anesthetic, since it provides a real anesthesia that includes hypnosis, analgesia and neuroendocrine protection, in addition to considerable amnesia. In addition, inadequate responses that for a time carried out its minimum use, could be minimized or avoided with the use of adjuvant drugs such as benzodiazepines and butyrophenones.This drug has contributed significantly to the anesthetic-analgesic knowledge, as well as depressive and schizophrenic symptoms. Today, it continues to shed light on the molecular basis of pain, hypnosis and the physiopathology of different neuropsychiatric disorders. Because of its unique pharmacological and clinical properties, as well as its newly discovered indications, CKTM currently has a wide variety of clinical applications. Both the neuroprotective, antiinflammatory and antitumor effects discovered in recent years, as well as the findings on the use of low dose regimens of CKTM, have helped to broaden the profile of clinical application of this drug. The important role it plays today is corroborated by the thousands of bibliographic quotes that continue to appear in the world medical literature.This review presents the main off label indications, excluding those of acute and chronic pain, such as its use in treatment-resistant depression, obsessive-compulsive disorders, posttraumatic stress, suicide, insomnia, electroconvulsive therapy, migraine, Parkinson's disease dyskinesia, bronchial asthma, sedoanalgesia of the critical patient, postoperative cognitive dysfunction, antitumor and traumatic therapy, etc. In summary, its versatility is confirmed, both in the multiple administration routes, as well as in the concepts of brain protector and perioperative analgesia enhancer in preventive analgesia. On the contrary, the presence of tolerance, hepatic enzymatic induction, as well as multiple and diverse adverse events have been reported with its chronic administration.