Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Edler, A.
The toxic effect of ketamine on the central nervous system - potential hazard or safe to use?
[ Diplomarbeit ] Medical University of Graz; 2012. pp. 49
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Sandner-Kiesling Andreas
- Wejbora Mischa
- Altmetrics:
- Abstract:
- Background: Increasing evidence points to a potential neurotoxic effect of the NMDA receptor antagonist ketamine when administered systemically and/or neuraxially. This article aims to review recent preclinical and clinical literature investigating the potential neurotoxic effect of ketamine on nerve or brain tissue. Methods: We searched Pubmed (1970 to 2012) and Embase (1988 to 2012). For data extraction, we followed the PRISMA-Statement in its current version. Results: From 1171 primary hits, 69 records were finally included into this systematic review. Animal studies: Out of 44, 33 showed a dose-dependent neurotoxicity of single or multiple doses ranging from 5-100 mg/kg systemically, and 0.5-10 mg/kg intrathecally (i.th.). Eleven studies failed to show significant neurotoxicity. Cell line studies: Out of 20, 16 discovered significant neurotoxicity in neuronal cells of young animals in a wide dose range from 0,001-21 mM and incubation time varying from1-72 hours. Three articles revealed neurotoxicity in human cell lines. Two studies failed to present neurotoxicity. Human Data: four case reports showed signs of neurodegeneration. One randomized controlled clinical trial showed no neurotoxicity of 2 mg/kg i.v. ketamine in children. Discussion: Our results indicate that under certain conditions ketamine can exert neurotoxicity inanimals and humans when administered systemically or neuraxially. In animals and cell lines, neurotoxic events depend on ketamine's dose, exposure time and the developmental age of the central nervous system at the time of application, with young mammals being more susceptible to ketamine toxicity than older. In humans, three case reports show neurotoxic histological changes post mortem after intrathecal application. Controversially, some evidence reports neuropro-tective effects of ketamine when it is added to chemically or ischemically injured neuronal tissue. Further research needs to clarify these questions.