katsetamine

Katsetamine, commonly known as ketamine, is a synthetic dissociative anesthetic in the arylcyclohexylamine class. It exists as a racemate of R(-)-ketamine and S(+)-ketamine; the S-enantiomer esketamine is marketed separately for some indications and generally has greater anesthetic potency.

Clinical use includes induction and maintenance of anesthesia, analgesia for postoperative pain, and sedation for various procedures. It is used in human and veterinary medicine. In subanesthetic doses, it can produce mood-altering, dissociative, and analgesic effects.

In recent years, ketamine has gained attention for treatment-resistant depression and suicidality. Subanesthetic intravenous or intranasal dosing can produce rapid antidepressant effects within hours, leading to approved esketamine nasal spray in several jurisdictions. Off-label uses include chronic pain and refractory anxiety in some settings.

Pharmacology involves antagonism of the NMDA receptor and interactions with opioid and monoaminergic systems, among others. The drug typically has a rapid onset after routes like intravenous or intramuscular injection, with a relatively short duration of action, requiring careful monitoring in clinical use.

Safety concerns include dissociation, perceptual disturbances, and emergence phenomena; cardiovascular stimulation causing hypertension or tachycardia; nausea; and potential for abuse or dependence with prolonged use. Chronic use has been linked to cystitis and cognitive changes in some individuals.

Contraindications include known psychotic disorders or active psychosis, significant cardiovascular disease, and increased intracranial pressure. Caution is advised during pregnancy and in liver disease or with concomitant sedatives or depressants.

History: Ketamine was developed in the 1960s by Parke-Davis, with clinical use beginning in the mid-1960s. It remains a widely used anesthetic and analgesic, as well as a subject of ongoing psychiatric research and regulatory oversight. Global legal status varies by country and schedule.