Ketamine; history and role in anesthetic pharmacology
Ketamine; history and role in anesthetic pharmacology
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DOI：
10.1016/j.neuropharm.2022.109171
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发表时间：
2022-06-29
影响因子：
4.7
通讯作者：
Lambert, David G.
中科院分区：
文献类型：
--
作者：
Hirota, Kazuyoshi;Lambert, David G.
氯胺酮（Ket）于1962年被开发出来，与苯环利定相比，它的致幻性较小，作用时间较短。1964年，它首次被用于人类。然而，Ket会产生一些不良反应，如颅内和血压升高以及癫痫发作，并且由于幻觉，患者仍然表现出较低的接受度。随着新的挥发性和静脉麻醉药的出现和不良反应的发展，Ket的使用明显减少。20世纪90年代，随着超短效阿片类药物瑞芬太尼的开发，大剂量阿片类药物可以在高侵入性手术中减轻手术压力。然而，大剂量阿片类药物可引起痛觉过敏和急性耐受性。由于Ket具有抗痛觉作用，临床对低剂量Ket的使用进行了重新考虑。Ket的其他有益作用，例如；对出血性和脓毒性损伤的镇痛、抗休克、抗炎作用、抗肿瘤作用、脑和脊髓神经保护以及支气管扩张等均有报道。此外，这种低剂量的麻醉剂最近被认为具有抗抑郁作用。这种多样化的形象使Ket远远超出了麻醉实践和手术室。
Ketamine (Ket) was developed in 1962 as a less hallucinogenic and shorter acting agent than phencyclidine. It was given to humans for the first time in 1964. However, Ket produces several adverse reactions such as raised intracranial and blood pressures along with seizures, and patients still show low acceptance due to hallucinations. As new volatile and intravenous anesthetic agents with good emergence and favorable side effect profiles were developed, Ket use markedly decreased. In the 1990s, as the ultrashort-acting opioid remifentanil was developed, high dose opioid could be used to reduce surgical stress in highly invasive procedures. However, high dose opioids can produce hyperalgesia and acute tolerance. As Ket can exert anti-hyperalgesic actions, the clinical use of low dose Ket has been reconsidered. Other beneficial effects of Ket such as; analgesia, anti-shock in hemorrhagic and septic insults, anti-inflammatory effects, anti-tumor effects, brain and spinal cord neuroprotection, and bronchodilation, have all been reported. Moreover, this anesthetic agent at low dose has been recently recognized to possess anti-depressive actions. This diverse profile extends Ket far beyond anesthesia practice and the operating room.