Regulatory update: Human abuse potential has created strong international pressure (China) to increase regulatory control. The commission on narcotic drugs elected not to upgrade the regulation of ketamine to schedule 1 in 2015, but there is still international debate. For more information see the fact sheet that was endorsed by a large number of human and veterinary organizations (in which the WSAVA played an extremely active role) regarding this issue: www.asahq.org/~/media/sites/gho/ketamine-fact-sheet-2015.
Usage update: Ketamine has uses that bridge: anesthetic (inexpensive and widely available in first through third world countries), amnesiac, cardiovascular sparing in intensive care, cerebra-protective, anti-glial activation, neuropathic pain and depression suppressing.
The Global Pain Council of the WSAVA utilizes ketamine extensively in the recommendations for countries where opioid analgesics, and safe non-steroidal analgesics are limited.
Recent human papers evaluating safety in:
1. Intensive care and cerebral perfusion in the ICU (not increasing ICP)
2. Reduced neurotoxicity and improved perfusion in neuro-anesthesia
3. Improved hemodynamics for sedations in ICU
4. Modification of neuropathic pain and anxiety disorders
Veterinary uses: Two primary considerations: Anesthesia and sedation:
Acute analgesia: NMDA antagonism reduces requirement for opioids, reduced post-operative pain, reduced wind-up at the level of the spinal cord and glia.
The Global Pain Council of the WSAVA utilizes ketamine extensively in the recommendations for countries where opioid analgesics and safe non-steroidal analgesics are limited. www.wsava.org/guidelines/global-pain-council-guidelines.
Chronic analgesia: NMDA antagonism mitigates glial hyper-activity and neuropathic pain
1. Spinal cord injury, brain injury peripheral nerve injury
2. Chronic OA
Low cost and high margin of safety at sub-anesthetic doses.
Systemic and peripheral applications:
Other NMDA antagonists:
1. Amantadine 2–5 mg/kg q12–24 hours
2. Memantine 0.3–0.5 mg/kg q12–24 hours