I received some news from the publications of various national societies of anesthesiologists about a real possibility that in the near future access to ketamine will not be as easy as it is today.
I sincerely believe that this will be a mistake.
I have practiced anesthesia for the last 30 years and, like many of my colleagues, I have resorted to the use of this drug in many cases using its significant advantages. I used it even during my residency at a pediatric rehabilitation hospital. The chief anesthesiologist there was seeking to sedate cerebral palsy patients before entering the operating room. Ketamine, administered orally, proved to be very effective for this aim. We administered it about 15 minutes before surgery, with a little water and sugar. Then, those small patients were sufficiently sedated and did not oppose establishing a venous access and adequate airway management, even in difficult cases.
I also witnessed its use in burn patients requiring repeated anesthesia. In this kind of case it produced residual analgesia and alleviated pain during periods of great discomfort.
At some point in my career, I thought that some new drugs could replace ketamine, but its place remains important even today. I cannot imagine multimodal analgesia in patients undergoing complex surgical procedures without a continuous infusion of low-dose ketamine.
Finally I want to mention that in my country we often encounter situations in which people with poor financial resources need various treatments, and medical and dental teams travel inland for a week or so in order to treat these patients. Some of them need anesthesia and in this situation ketamine is the drug of choice. It lacks any respiratory effect and preserves the blood pressure.
I am convinced that there are many countries where the situation is similar and where anesthesiologists use ketamine for its advantages and safety.
For all the above, I cannot believe that we will not have this drug. Ketamine has to be part of our daily pharmacological arsenal.
Francisco Carlos Bonofiglio
Hospital Italiano de Buenos Aires
Editor note: Since the receiving of the above letter the WHO Expert Committee on Drug Dependence, ECDD, have already recommended not to schedule ketamine.