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10.01.2018 | review article | Ausgabe 9-10/2018 Open Access

Wiener klinische Wochenschrift 9-10/2018

S(+)-ketamine

Current trends in emergency and intensive care medicine

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 9-10/2018
Autoren:
MSc Prim. Dr. Helmut Trimmel, PD OA Dr. Raimund Helbok, Prof. Dr. Thomas Staudinger, OA Dr. Wolfgang Jaksch, OÄ Dr. Brigitte Messerer, PD OA Dr. Herbert Schöchl, MSc Prim. Prof. Dr. Rudolf Likar
Wichtige Hinweise
The original version of this article was revised due to a retrospective Open Access order.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00508-018-1354-8.

Summary

S(+)-ketamine, the pure dextrorotatory enantiomer of ketamine has been available for clinical use in analgesia and anesthesia for more than 25 years. The main effects are mediated by non-competitive inhibition of the N-methyl-D-aspartate (NMDA) receptor but S(+)-ketamine also interacts with opioid receptors, monoamine receptors, adenosine receptors and other purinergic receptors. Effects on α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, metabotropic glutamate receptors (mGluR) and L‑type calcium chanels have also been described. S(+)-ketamine stimulates the sympathetic nerve system, making it an ideal drug for analgosedation or induction of anesthesia in instable patients. In addition, the neuroprotective properties, bronchodilatory, antihyperalgesic or antiepileptic effects provide interesting therapeutic options. In this article we discuss the numerous effects of S(+)-ketamine under pharmacological and clinical aspects especially for typical indications in emergency medicine as well as intensive care.

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