LAUSR

K was approved for use as an anesthetic agent by the US Food and Drug Administration (FDA) in 19701 and is an analog of the hallucinogen phencyclidine, commonly known as PCP. Ketamine’s development was driven by the observation that phencyclidine was a useful anesthetic agent but caused serious neuropsychiatric adverse events (eg, delirium, psychosis, dissociative states).2 Despite being one-tenth as potent as phencyclidine, ketamine was recognized as a drug associated with neuropsychiatric adverse events. These neuropsychiatric events led to ketamine being exploited illegally. In the 1990s, increasing reports of recreational ketamine use resulted in the FDA reclassifying ketamine as a schedule III-controlled substance.3 Despite concerns of drug diversion or abuse, the number of clinical and experimental uses of ketamine in a variety of patient populations has grown significantly over the last decade. This growth is due in part to ketamine’s unique pharmacologic profile. Uses beyond the FDA-approved indication as an anesthetic include the management of various pain types (eg, neuropathic, musculoskeletal, burn related), procedural sedation and sedation during rapid sequence intubation (RSI), rapid amelioration of depressed mood, alcohol withdrawal management, acute undifferentiated agitation, continuous infusion sedation, and status epilepticus.2,4,5 In this Drug Update column, practical considerations for use of ketamine in the intensive care unit (ICU) are reviewed, as are its most common uses, including as an analgesic and during RSI and procedural sedation.