Perioperative ketamine for acute analgesia and beyond.

There has been substantial interest in the use of ketamine for perioperative analgesia. Recently published articles on 'low dose' ketamine mark the resurgence in interest in the use of the drug for acute pain. Continued interest in ketamine as an anti-depressant also has opened the door to applications beyond the operating room. In this article, we will review: the history of ketamine's clinical use; basic ketamine pharmacology; evidence for the use of perioperative ketamine for analgesia; comments on patient selection for ketamine research; a discussion of the safety and side effect profile of ketamine infusions beyond the operating room; and, lastly, ketamine as a treatment option for psychiatric diseases.