Update on the Physiologic Effects of Ketamine in General Anesthesia and Spinal Blockade: A Review of the Literature.

Ketamine, a phencyclidine analog and dissociative anesthetic, has been used in anesthesia since the 1960s. Serial subanesthetic administration has been explored for treatment of depression and chronic pain; however, there has been a recent surge in its intraoperative and perioperative use among anesthesia providers. As ketamine becomes an important addition to multimodal acute pain regimens, it important that anesthesia providers review the physiologic underpinnings of ketamine administration. Herein, we review the primary scientific literature and discuss recent studies that have implicated ketamine in inflammation and oxidative stress, inhibition of ion channels in dorsal horn neurons, and in disruption of frontoparietal communication. Also discussed are the potential clinical implications these effects may have for patients.