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Canadian Journal of Anaesthesia

, Volume 36, Issue 2, pp 186–197 | Cite as

Ketamine: an update on the first twenty-five years of clinical experience

  • David L. Reich
  • George Silvay
Special Article

Key words

ANAESTHETICS INTRAVENOUS: ketamine 

Résumé

Pendant presque 25 ans ďexpérience clinique, les bénéfices et les limitations de ľanesthésie à la kétamine ont été généralement bien définis. Les revues extensives de White et al.2 ainsi que celles de Reeves et al.43 ont énormément aidé à comprendre ľanesthésie dissociative. Néanmoins, des études récentes continuent à nous éclairer sur les différents aspects de la pharmacologie de la kétamine et suggèrent de nouvelles utilisations cliniques de cette drogue. Ľidentification du récepteur du N-M ethyl-Aspartate amène une preuve que ľanesthésie et ľanalgésie à la kétamine ont chacune un mécanisme ďaction différent. La liaison stéréospécifique de la (+) kétamine aux récepteurs opiacés in vitro, ľémergence plus rapide de ľanesthésie, et une incidence plus basse de séquelles lors de ľémergence, rend la (+) kétamine une drogue promettante pour des recherches futures. Les applications cliniques de la kétamine qui ressortent récemment, et qui probablement augmenteront dans le futur sont reliées é ľutilisation orale, rectale et intra-nasale de la kétamine pour des fins ďanalgésie, de sédation ou induction anesthésique. La kétamine est actuellement considérée comme une option raisonnable pour ľinduction anesthésique chez les nouveau-nés prématurés en hypotension. Ľexpérience initiale avec la kétamine en injection épidurale et intrathécale ne fut pas prometteuse et les données sont encore préliminaires dans ce domaine. Ľutilisation de la kétamine dans les catastrophes et les manoeuvres militaires va probablement être plus fréquente. La disponibilité clinique du midazolam va complementer ľanesthésie à la kétamine de plusieurs façons. Cette benzodiazépine est rapidement métabolisée. Elle réduit la stimulation cardiovasculaire de la kétamine ainsi que les phénomènes ďémergence sans avoir des métabolites actifs. Elle est disponible sous une forme aqueuse et n’est pas irritante lors de ľinjection intra-veineuse comme le diazépam. La combinaison de la kétamine et du midazolam sera bien acceptée par les patients contrairement à ce qui arrive quand on utilise la kétamine seule. Finalement, il est nécessaire de mentionner la possibilité ďabus de la kétamine.126 Alors que la kétamine n’est pas une substance contrôlée (aux États-Unis) la prudence suggère aux médecins de prendre des précautions appropriées contre son utilisation non-autorisée.

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Copyright information

© Canadian Anesthesiologists 1989

Authors and Affiliations

  • David L. Reich
    • 1
  • George Silvay
    • 1
  1. 1.Department of AnaesthesiologyMount Sinai Medical Center, One Gustave L. Levy PlaceNew YorkU.S.A.

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