Ketamine is a psychedelic???
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Ketamine is a weird drug, and my experiences with it date back to (gasp) 1974.
First of all, in larger doses, about 2 mg/kg IV it's a good induction agent for general anesthesia. It doesn't cause significant hypotension (like Pentothal used to). As a 1-time dose, any effects from it are pretty much gone in half an hour. It's a good drug to induce anesthesia in trauma/bleeding cases because it won't bottom out the BP. It's said (probably apocryphal) that thiopental killed more GIs at Pearl Harbor than the Japanese.
We had a dentist who did a lot of work with children with all kinds of developmental disabilities. The severe autistic kids were difficult. You couldn't get near them to start an IV, and just separating them from mom/caretaker was often a challenge. We'd use an intramuscular ketamine "dart." About 5 mg/kg was enough. You'd sneak up on the kid, and hit them with the injection before they knew what happened. In 3-5 minutes, they'd go limp, and fall asleep. Put 'em on a cart and off to the OR.
In smaller doses (0.25 - 0.5 mg/kg) it is an excellent analgesic. I would use it frequently during c-sections when the epidural was just not "good enough." Supplemented with about 100 ug of fentanyl it was great for "getting over the hump." When I was teaching residents, I'd tell them to give fentanyl until the patient developed some miosis (small pupils), and enough ketamine to the point where the eyes would twitch with some nystagmus.
One of my partners would routinely mix ketamine with propofol for infusion in "sedation" cases - such as endoscopies, etc. Worked great. Seems like you needed less propofol that way. Propofol has no intrinsic analgesic properties so it made sense to use some ketamine in the mix.
In the lower dose range, some patients develop hallucinations or any overall "weird" feeling. Some would describe an "out of body experience." I always considered it as a hallucinogenic in the moderate doses.
THere's lots of stuff coming out regarding ketamine as a treatment for depression. Granted, I've not followed that aspect of it much, but there's a lot being done.
It's a weird, weird drug with many properties, based on dose, route of administration, etc. PCP (phencyclidine) is a close chemical relative, though it seems that PCP has mostly hallucinogenic properties. Weird drug.
In my practice, I didn't use it all that often, only in the cases described above.
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“I am fond of pigs. Dogs look up to us. Cats look down on us. Pigs treat us as equals.” ~Winston S. Churchill
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@Mik said in Ketamine is a psychedelic???:
PCP is just dissociative in my experience.
Yes. Ketamine is often referred to as a "dissociative anesthetic." Patients describe it as being disconnected from reality. But, there are "ketamine hallucinations". Rarely, they can persist into the post-op period.
Unpleasant.
In larger doses, I imagine it is. One patient described it as feeling as though they were "encased in styrofoam." However, my use was usually smaller doses (OB, etc). Good analgesic, but too much baggage with other stuff why I used it infrequently.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7572586/
A good (though older) overview:
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As I said, it's a weird drug. It does so much, and so differently in different people. Effects and efficacy seem to be very dose-dependent. It's only in the last 15-20 years that we're seeing the multiple effects that ketamine has.
If it finds mainstream acceptance in other fields, I wouldn't be surprised to see more specific related drugs being developed.
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I would never consider ketamine as a recreational drug.
Wanna trip? Take something trippy.
Wanna relax? Smoke something.
Wanna have some euphoria? There are options.Ketamine is too weird. Also, in today's world, you don't know what you're getting, or how much.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
