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Ketamine: Beyond Anesthesia

Classically used as a surgical anesthetic, the drug ketamine – which is also a drug of abuse – is showing effectiveness in alternative fields to the classic application.

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“I’ve seen a light at the end of the tunnel.” This is the well-known phrase that the mass media, through popular culture, have given us as a representation of what some consider “extracorporeal experiences” or “close to death”. But, beyond supernatural considerations, there is a known anesthetic drug that may be behind some of these experiences: ketamine.

Some of the people who relate these experiences of extracorporeal escape and perception of it -from a point of view away from the physical body itself- were at that moment feeling subjected to a surgical intervention under the sedative effects of ketamine.

We are talking about a drug that has powerful psychotropic properties; those popular phenomena of escape and travel through the tunnel at the time of death found a scientific logic.

Ketamine is capable, like other recreational drugs, of generating phenomena of perceptual dissociation in which the composition of perceptions, in the sensory modality that is – including the perception of time and that of oneself as an integral, but differentiated, being – it occurs in a disorderly or illogical way.

Therefore, the final perceptual phenomenon emerges distorted, intermingled; intermodal sensory transferences (such as hearing a color, tasting a sound, etc.) occur and, in somewhat more extreme cases, the directional sense of time changes or reverts, expands or contracts, and the person stops recognizing their own limits physical and bodily members.

The multisensory hallucinations – visual, auditory, gustatory, tactile and olfactory – are then given frequently, as well as the ‘in situ’ experience of real spatial and temporal episodes far from the temporo-spatiality of the present moment and place of the individual – phenomenon informally known as’ travel’-.

Very often, and according to the stories of the people affected, real dialectical and experiential exchanges with deceased people, fictional characters, or even a different version of oneself; It is also common for the subjective belief to have died and for the individual to experience anxious exaltation and exorbitant emotions – especially those related to fear.

At therapeutic and controlled doses, such as in an operating table, these psychoactive effects are reversible and transient, while ingested in different doses, ketamine can induce a deep dissociative state (popularly known as “K-hole”).

It can also induce the perception of things, people and situations that are not real to an extreme that is difficult to reconcile with one’s own reality, and at great risk of causing sequelae or promoting psychotic outbreaks in people biologically predisposed to it.

This problem made the use of ketamine a highly controversial issue, and therefore its legal use in humans has been restricted in recent years -employed, sometimes, only as a last resort-, remaining as the anesthetic of choice in large veterinary surgery. animals.

What is ketamine?

Ketamine is a type of medication used essentially for the induction and maintenance of anesthesia in human surgery, both adult and pediatric. It has the ability to induce a state similar to trance, while providing:

  • Pain relief.
  • Sedation.
  • Memory loss.

In addition to this surgical use, which is also extensive to veterinary science, ketamine is used in the management of chronic pain and for rapid sedation in the Intensive Care Unit (ICU).

While the drug exerts its effects, a relative conservation of cardiac, respiratory and various reflexes is observed. Normally, it is not until the effects begin to weaken that undesirable side reactions appear, such as:

  • Elevation of blood pressure.
  • Respiratory depression
  • Involuntary muscle contractions
  • Agitation.
  • Confusion.
  • Hallucinations.

These are the effects attributable to this drug when it is used, illegally and for recreational purposes, at higher doses or administered differently from the strictly clinical ones.

Alternative uses of ketamine

In spite of its bad reputation, the political and legal impediments that surround this substance -considered now widely as an addictive drug-, to the reticence of the private sphere.

nica, pharmaceutical and the group of patients themselves, there are numerous investigations that have been made about alternative uses.

“Declare the past, diagnose the present, predict the future.”

-Hocócrates-

Its mechanism of action involves selectively blocking the well-known NMDA receptor (N-methyl-d-aspartate), which in addition to globally reducing brain activity also hinders mnestic retention and temporarily relieves depressive symptoms.

This action, along with its pharmacokinetics and pharmacodynamics, makes ketamine a powerful anesthetic and sedative; very practical for medical applications, but also makes it a strong dissociative drug, precisely because of its link to the NMDA receptor.

In addition to the mentioned uses -considered as ‘typical’ in clinical practice-, there are other less exploited uses for which ketamine seems to be an effective alternative:

  • As a coadjuvant in the treatment of depression.
  • As a hypnotic or inducer to sleep.
  • To reduce the incidence of epileptic seizures.
  • As a neuroprotector, especially in cases of brain damage.
  • To help mitigate the effects of post-traumatic stress disorder and also in the treatment of obsessive-compulsive disorder.
  • As a reducer of asthmatic symptoms.

Ketamine and depression

Among all the new and surprising uses attributable to ketamine, the one that seems to be most interesting, and which according to all indications will receive clinical application and commercialization, is its use as a complement to antidepressant therapy.

In this regard, and quite apart from the widely accepted monoaminergic hypothesis that for many decades has fueled the research and generation of families of antidepressant drugs, the real news is that, precisely, the most benefited are those who have responded the worst common antidepressants.

That is, ketamine acts where other antidepressants do not; It is giving good results in people whose depression is resistant to common drugs. A result that very few scientists thought to contemplate.

Sometimes solutions are much closer than we think; our eagerness for great deeds makes us look towards new horizons when, possibly, we have an answer before ourselves.

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