S(+)-ketamin: Review of pharmacological properties and use in clinical practice (S(+)-ketamin: Pharmacology and clinical use)

Abstract

Ketamine is a phenylcyclidine derivative that was first synthesized in 1962, and it was approved for clinical use in 1970. The racemic mixture of ketamine consists of two optical isomers -R(-)-enantiomer and S(+)-enantiomer. S-isomer is twice as potent as the racemic mixture, it is eliminated faster, resulting in a shorter active period of the drug and faster recovery time. It affects the body through the N-methyl-D-aspartate receptor as well as numerous other receptors of neurotransmitter systems. S(+)-keta-mine, similarly to racemic mixture of ketamine, leads to stimulation of the cardiovascular system, bronchodilation, inhibition of the inflammatory response and the dissociative anesthesia. It is mainly used in the pediatric population, due to the lower frequency of adverse effects, especially psychomimetic phenomena. It is used for induction and maintenance of general anesthesia as well as for procedural sedation. Due to its potent analgesic effect, it is used to relieve postoperative pain, neuropathic pain, and there are reports of successful control of cancer-resistant pain. Although the question of the influence of esketamine on intracranial pressure is controversial, with adequate co-med-ication, esketamine can lead to a successful lowering of intracranial pressure. Due to its good hemodynamic stability and analgesia, S(+)-ketamine is probably the anesthetic/ sedative of first choice in burn patients. Other indications are: status asthmaticus, status epilepticus, antidepressant effect, sedation in intensive care units, sedation for short surgical interventions, etc. Co-medication is advised, especially with benzodiazepines, the most common of which is midazolam.