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Psychiatric side effects of ketamine in hospitalized medical patients administered subanesthetic doses for pain control

Published online by Cambridge University Press:  14 November 2013

Keith G. Rasmussen*
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, MN, USA
*
Keith G. Rasmussen, Department of Psychiatry and Psychology, Mayo Clinic, Generose 3-110, Rochester, MN 55905, USA. Tel.: +507 255 2326; Fax: +507 284 3933; E-mail: rasmussen.keith@mayo.edu

Abstract

Objective

To assess the psychiatric side effects of ketamine when administered in subanesthetic doses to hospitalized patients. It is hypothesized that such effects occur frequently.

Methods

In this retrospective study, the medical records of 50 patients hospitalized on medical and surgical units at our facility who had continuous intravenous infusions of ketamine for pain or mild sedation were reviewed. Patient progress in the days following the start of ketamine infusion was reviewed and response to ketamine was noted.

Results

Twenty-two percent of the patients were noted to have some type of psychiatric reaction to ketamine, including agitation, confusion, and hallucinations. These reactions were relatively short lived, namely, occurring during or shortly after the infusions. No association was found between patient response to ketamine and gender, age, or infusion rate.

Conclusion

Awareness of the psychiatric side effects of ketamine is an important consideration for clinicians administering this medication either for pain control or for depressive illness.

Type
Original Articles
Copyright
Copyright © Scandinavian College of Neuropsychopharmacology 2013 

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References

1. Hocking, G, Cousins, MJ. Ketamine in chronic pain management: an evidence-based review. Anesth Analg 2003;97:17301739.CrossRefGoogle ScholarPubMed
2. Noppers, I, Niesters, M, Aarts, L, Smith, T, Sarton, E, Dahan, A. Ketamine for the treatment of chronic non-cancer pain. Expert Opin Pharmacother 2010;11:24172429.Google Scholar
3. Laskowski, K, Stirling, A, Mckay, W, Lim, H. A systematic review of intravenous ketamine for postoperative analgesia. Can J Anesth 2011;58:911923.CrossRefGoogle ScholarPubMed
4. Correll, GE, Maleki, J, Gracely, EJ, Muir, JJ, Harbut, RE. Subanesthetic ketamine infusion therapy: a retrospective analysis of a novel therapeutic approach to complex regional pain syndrome. Pain Med 2004;5:263275.Google Scholar
5. Berman, RM, Cappiello, A, Annand, A et al. Antidepressant effects of ketamine in depressed patients. Biol Psychiatry 2000;47:351354.CrossRefGoogle ScholarPubMed
6. Rasmussen, KG, Lineberry, TW, Galardy, CW et al. Serial infusions of low-dose ketamine for major depression. J Psychopharmacol 2013;27:444450.Google Scholar
7. Morgan, CJA, Curran, HV. Ketamine use: a review. Addiction 2012;107:2738.Google Scholar
8. Krystal, JH, Karper, LP, Seibyl, JP et al. Subanesthetic effects of the noncompetitive NMDA antagonist, ketamine, in humans. Psychotomimetic, perceptual, cognitive, and neuroendocrine responses. Arch Gen Psychiatry 1994;51:199214.Google Scholar
9. Honey, GD, Corlett, PR, Absalom, AR et al. Individual differences in psychotic effects of ketamine are predicted by brain function measured under placebo. J Neurosci 2008;28:62956303.Google Scholar
10. Pomarol-Clotet, E, Honey, GD, Murray, GK et al. Psychological effects of ketamine in healthy volunteers: phenomenological study. Br J Psychiatry 2006;189:173179.CrossRefGoogle ScholarPubMed
11. Bowdle, TA, Radant, AD, Cowley, DS, Kharasch, ED, Strassman, RJ, Roy-Byrne, PP. Psychedelic effects of ketamine in healthy volunteers. Relationship to steady-state plasma concentrations. Anesthesiology 1998;88:8288.Google Scholar
12. Gouzoulis-Mayfrank, E, Heekeren, K, Neukirch, A et al. Psychological effects of (S)-ketamine and N,N-dimethyltryptamine (DMT): a double-blind, cross-over study in healthy volunteers. Pharmacopsychiatry 2005;38:301311.CrossRefGoogle Scholar