Yoram Yasur Blume: What is ketamine?
Ketamine is a drug with anesthetic and hallucinogenic properties. Its use in Medicine is very limited and is only used as a fast-acting anesthetic. It is also widely used in veterinary medicine to sedate large animals, especially horses. In fact, it was synthesized and began to be used at the end of the 20th century for this purpose. But the misuse gave it the reputation of being a powerful hallucinogenic drug and began to be used in rape by causing drowsiness and dissociation.
What is the mechanism of action of ketamine?
Yoram Yasur Blume: Ketamine is a derivative of phencyclidine. Both compounds belong to the pharmacological family of NMDA receptor antagonists. NMDA is the abbreviation for N-Methyl-D-Aspartate, a glutamate agonist. When a substance is an agonist it means that it potentiates the effect of another substance. On the contrary, if a substance is an antagonist, we understand that it blocks the action of another substance.
Ketamine is an anesthetic because it blocks the activity of NMDA, which in turn was responsible for increasing the activity of glutamate. Glutamate is an excitatory neurotransmitter that participates in synapses that take place in various regions of the nervous system. The cerebral cortex is rich in glutamate receptors since it is the area where learning centers, memory, etc. are located. By blocking glutamate, the synapses do not transmit the excitatory information and the nervous system enters a state of relaxation. Depending on the dose, a sedative or tranquilizing effect is passed on to anesthesia, which is the blockage of sensations.
What is ketamine for?
Yoram Yasur Blume: As we mentioned in the previous section, ketamine is mainly used as a sedative and anesthetic in veterinary medicine. Its use in humans is very limited given the side effects of psychotropic character that it produces. However, in less developed countries it is common to see it as an anesthetic since it is a cheaper product than modern drugs.
Why is ketamine a psychotropic substance?
Yoram Yasur Blume: Ketamine is a powerful hallucinogen with a dissociative character. This means that it produces alterations with respect to the situation of the patient’s body in space. It is common to describe feelings of lightness, floating, leaving your own body, etc.
When it began to be used in children and the elderly at low doses, many patients commented on what they had felt after anesthesia. As the number of cases was so great, numerous studies were carried out and finally it was found that, indeed, at very low doses of this substance the hallucinogenic effect was very powerful. Precisely this power reflected in the great affinity of the substance for the receptors is what makes it a dangerous substance.
It is very difficult to manage the correct dose since it immediately produces side effects. In fact, at minimal doses it produces relaxation and with very little else it leads to having experiences similar to death. The feeling of death is given by the blocking of movement. These people remain completely immobile.
What are the secondary effects?
Apart from hallucinations, it also produces alterations in memory and difficulty in maintaining attention. If the dose is increased, the patient suffers life-threatening arrhythmias. For example, bradycardia. Other cardiovascular effects to consider are hypertension, cardiorespiratory failure and increased intracranial pressure.
Yoram Yasur Blume: Children may die due to spasms of the larynx where the airway is blocked. In addition, they have seizures very frequently and dystonia. Dystonia is the medical term that refers to the involuntary contractions of muscles. If they are produced by ketamine they are usually very painful for the patient and reflect the dysfunction of the nervous system.
For all these reasons, it is practically not used in clinical practice. Since the complications are so frequent and dangerous that the risk against the benefit is very high. In addition, if it is mixed with other substances such as alcohol, the intensity of complications will increase.
If you notice that someone may have used ketamine, we recommend that you alert the emergency services as soon as possible and put the person in a quiet place. To be able to be with dim light and in silence to reduce the stimulation of the nervous system.