Esketamine Kalceks
Injectable Anaesthetic for General Anaesthesia, Sedation and Emergency Pain Relief
Quick Facts About Esketamine Kalceks
Key Takeaways About Esketamine Kalceks
- Twice the potency of racemic ketamine: Esketamine is the S(+)-enantiomer and has approximately double the anaesthetic potency, allowing lower doses and potentially fewer side effects
- Unique dissociative anaesthesia: Unlike most anaesthetics, esketamine preserves spontaneous breathing and protective airway reflexes at standard anaesthetic doses
- Emergence reactions are common: Vivid dreams, nightmares, dizziness, and restlessness can occur during recovery – benzodiazepine pre-treatment reduces their incidence
- Raises blood pressure and heart rate: Esketamine stimulates the cardiovascular system, making it unsuitable for patients with uncontrolled hypertension or conditions where raised blood pressure is hazardous
- Hospital or emergency use only: This medicine must be administered by or under the supervision of an anaesthesiologist in a fully equipped clinical environment
What Is Esketamine Kalceks and What Is It Used For?
Esketamine Kalceks is an injectable anaesthetic that belongs to the group of general anaesthetics (NMDA receptor antagonists). It is used to induce and maintain general anaesthesia, provide pain relief in emergency situations, and supplement regional or local anaesthesia. It is the purified S(+)-enantiomer of ketamine, with approximately twice the anaesthetic potency.
Esketamine produces a unique state of anaesthesia known as dissociative anaesthesia. In this state, the patient appears to be in a trance-like condition, characterised by profound analgesia (pain relief), amnesia (inability to recall the procedure), and catalepsy (a state of muscle rigidity with maintained postural reflexes), while certain protective reflexes, including breathing, are preserved. This distinguishes esketamine from most other general anaesthetics, which cause significant respiratory depression.
The mechanism of action of esketamine centres on its role as a non-competitive antagonist at the NMDA (N-methyl-D-aspartate) receptor. By blocking these glutamate-gated ion channels, esketamine interrupts the transmission of pain signals in the central nervous system and produces its characteristic dissociative effects. Esketamine binds to the NMDA receptor with approximately two to three times greater affinity than its R(-)-enantiomer, which accounts for its superior anaesthetic and analgesic potency compared to racemic ketamine.
Esketamine Kalceks can be used in several clinical scenarios. As a sole anaesthetic agent, it is particularly valuable for short surgical and diagnostic procedures that do not require skeletal muscle relaxation. In combination with other anaesthetic agents, including inhalational anaesthetics, opioids, and muscle relaxants, it can be used for longer and more complex surgical procedures. In emergency medicine and pre-hospital care, esketamine is widely used for rapid analgesia and sedation in trauma patients, burns, and other acute pain situations, as it preserves cardiovascular stability and spontaneous respiration.
Esketamine is also used as a supplement to regional or local anaesthesia, providing additional analgesia and sedation during procedures performed under spinal, epidural, or nerve block anaesthesia. This application is particularly useful in situations where regional anaesthesia alone may not provide sufficient patient comfort.
Esketamine was developed to offer the clinical benefits of racemic ketamine with improved potency and a potentially more favourable side-effect profile. It is approved for use in numerous European countries under the names Esketamine Kalceks, Ketanest, and Esketamine Ethypharm. The closely related nasal spray formulation (Spravato) contains esketamine but is approved for a different indication: treatment-resistant depression.
What Should You Know Before Receiving Esketamine Kalceks?
Before receiving esketamine, your anaesthesiologist must be informed about all your medical conditions, especially cardiovascular disease, raised intracranial pressure, psychiatric history, and all medications you are taking. Several conditions are absolute contraindications to esketamine use.
Contraindications
You should not receive Esketamine Kalceks if any of the following apply to you:
- Allergy to esketamine, ketamine, or any excipient – including sodium chloride, hydrochloric acid, or water for injections
- Conditions where raised blood pressure would be dangerous – such as poorly controlled hypertension, pre-eclampsia, or eclampsia. Esketamine can significantly increase blood pressure and is contraindicated when this would pose a serious risk
- Raised intracranial pressure – esketamine may further increase intracranial pressure, which can be life-threatening in patients with head injuries or intracranial pathology
- Angina pectoris or heart disease when used as sole anaesthetic – esketamine should not be the only anaesthetic agent in patients with significant coronary artery disease, as it increases myocardial oxygen demand through sympathetic stimulation
- Eclampsia or pre-eclampsia – the blood pressure-raising effect of esketamine is particularly dangerous in these pregnancy-related conditions
- Concurrent use with xanthine derivatives and ergometrine – these combinations are contraindicated due to the risk of seizures (xanthines) or dangerous cardiovascular effects (ergometrine)
Warnings and Precautions
Talk to your anaesthesiologist before receiving Esketamine Kalceks if you have or have had any of the following conditions:
- Hypovolaemia or dehydration – reduced blood volume may alter your response to esketamine and affect cardiovascular stability
- Heart disease (heart failure, coronary artery disease) with untreated high blood pressure – esketamine stimulates the sympathetic nervous system, increasing heart rate and blood pressure
- Recent chest pain or heart attack (within the past 6 months) – the cardiovascular stimulation caused by esketamine may be particularly dangerous in this situation
- Heart rhythm disorders (arrhythmias) – esketamine can affect cardiac conduction and rhythm
- Raised intracranial pressure with CNS injury or disease – increased intracranial and intraspinal pressure has been observed with ketamine-type anaesthetics
- Respiratory infections (pulmonary or upper airway) – esketamine increases salivary and bronchial secretions, which may complicate airway management in patients with respiratory infections
- Raised intraocular pressure (e.g. glaucoma, eye injury) – esketamine can further increase intraocular pressure and is not suitable for eye examinations or procedures requiring low intraocular pressure
- Acute intermittent porphyria – a rare metabolic disorder that may be triggered by certain anaesthetic agents
- Alcohol intoxication – alcohol interacts with esketamine, potentially causing unpredictable CNS effects
- Psychiatric disorders (past or present) – esketamine can cause hallucinations, confusion, and dissociative symptoms, which may exacerbate underlying psychiatric conditions
- Untreated hyperthyroidism – the sympathomimetic effects of esketamine can worsen symptoms of thyroid overactivity
- Liver disease – esketamine is metabolised by the liver, and dose reduction should be considered in patients with hepatic impairment
- History of substance misuse or dependence – esketamine has potential for abuse, and patients with a history of substance use disorders require careful monitoring
If esketamine is administered as part of an outpatient (day-case) procedure, you should be accompanied by a responsible adult when going home. You must not drink alcohol for at least 24 hours after receiving esketamine, as alcohol can interact with any residual effects of the anaesthetic.
Pregnancy and Breastfeeding
If you are pregnant, think you might be pregnant, planning to become pregnant, or are breastfeeding, you must inform your anaesthesiologist before receiving Esketamine Kalceks.
Pregnancy: Esketamine should not be used during pregnancy unless the treating physician determines that the potential benefits clearly outweigh the risks to the developing foetus. Animal studies have not provided sufficient data to fully exclude reproductive risks. If esketamine is administered during labour and delivery, it may affect the newborn's respiratory rate and breathing pattern, requiring monitoring of the baby after birth. Particular caution is needed in situations during delivery where uterine muscle relaxation is required (such as threatened uterine rupture or umbilical cord prolapse).
Breastfeeding: Esketamine can pass into breast milk. However, at recommended therapeutic doses, the risk of clinically significant effects on the nursing infant is considered unlikely. Your doctor will advise you on whether breastfeeding can be continued after receiving esketamine.
Driving and Operating Machinery
Esketamine significantly impairs reaction time, coordination, and cognitive function. You must not drive, operate machinery, or engage in activities requiring alertness for at least 24 hours after receiving this medicine. The effects on psychomotor function can persist well beyond the period of apparent anaesthesia, and you may feel alert before your reactions have fully recovered.
Sodium Content
Esketamine Kalceks 5 mg/ml contains 3.2 mg sodium per ml of solution, equivalent to 0.16% of the WHO recommended maximum daily intake of sodium for adults. Esketamine Kalceks 25 mg/ml contains 1.2 mg sodium per ml, equivalent to 0.06% of the maximum daily intake. These amounts are considered clinically negligible.
How Does Esketamine Kalceks Interact with Other Drugs?
Esketamine interacts with several medication classes, including sympathomimetics, barbiturates, benzodiazepines, opioids, inhalational anaesthetics, and xanthine derivatives. Your anaesthesiologist will carefully review all your medications before administration to avoid potentially dangerous interactions.
Esketamine is primarily metabolised by the liver enzymes CYP3A4 and CYP2B6. Drugs that inhibit or induce these enzymes can alter esketamine blood levels and its clinical effects. Additionally, esketamine has significant interactions with cardiovascular and CNS-active drugs due to its unique pharmacological profile. The following tables summarise the most clinically important interactions.
Major Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Xanthine derivatives (theophylline, aminophylline) | Bronchodilator | Can cause epileptic seizures or convulsions when combined with esketamine | Combination is contraindicated – must be avoided |
| Ergometrine | Oxytocic (labour induction) | Risk of dangerous cardiovascular effects when combined with esketamine | Combination is contraindicated – must be avoided |
| Sympathomimetics (adrenaline, noradrenaline) | Cardiovascular / Emergency | Can cause excessive blood pressure elevation, increased heart rate, and cardiac arrhythmias | Use with extreme caution; close haemodynamic monitoring required |
| Thyroid hormones | Endocrine | Can increase blood pressure, raise heart rate, or cause cardiac rhythm disturbances | Use with caution; ensure thyroid function is adequately treated before anaesthesia |
Moderate Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Benzodiazepines (diazepam, midazolam) | Sedative / Anxiolytic | Can prolong the duration of esketamine’s effects; however, may reduce emergence reactions | Often co-administered intentionally to reduce emergence reactions; dose adjustment needed |
| Barbiturates (thiopental) | Anaesthetic / Sedative | Can prolong the recovery phase after anaesthesia | Monitor recovery closely; adjust doses as needed |
| Opioids (morphine, fentanyl) | Analgesic | Concurrent use can prolong the recovery period from anaesthesia | Monitor recovery time; reduce doses of both agents if possible |
| Inhalational anaesthetics (halothane, isoflurane, sevoflurane, desflurane) | General Anaesthetic | Esketamine enhances the analgesic effect; a dose reduction of the inhalational agent may be necessary | Reduce inhalational anaesthetic dose; monitor depth of anaesthesia |
| Muscle relaxants (pancuronium, suxamethonium) | Neuromuscular blocking agent | Esketamine may prolong the duration of neuromuscular blockade | Monitor neuromuscular function; adjust relaxant doses accordingly |
| CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) | Various | May increase esketamine blood levels by inhibiting its metabolism | Consider reducing esketamine dose when co-administered with strong CYP3A4 inhibitors |
| CYP3A4 inducers (rifampicin, carbamazepine, phenytoin) | Various | May decrease esketamine blood levels by accelerating its metabolism | Consider increasing esketamine dose when co-administered with strong CYP3A4 inducers |
Food, Drink and Alcohol
As with all general anaesthetic agents, you should fast for 4 to 6 hours before receiving Esketamine Kalceks (no food or drink) to minimise the risk of aspiration during anaesthesia. You must not consume alcohol for at least 24 hours after receiving this anaesthetic, as alcohol can potentiate residual CNS-depressant effects and impair recovery.
What Is the Correct Dosage of Esketamine Kalceks?
Esketamine Kalceks is administered by an anaesthesiologist as a slow intravenous injection, intramuscular injection, or continuous intravenous infusion. The dose is individualised based on the patient's age, weight, clinical condition, and the type of procedure. It is never self-administered.
Esketamine dosing is always determined and administered by an anaesthesiologist or appropriately trained physician. The following dosage information is provided for informational purposes only and represents typical dose ranges used in clinical practice. Actual doses may vary significantly depending on individual patient factors, concurrent medications, and the specific clinical scenario.
Adults – Intravenous Administration
Induction of Anaesthesia (IV)
Dose: 0.5–1 mg/kg body weight, administered as a slow intravenous injection
Onset: Approximately 1 minute
Duration: 10–15 minutes
The injection should be given slowly over at least 60 seconds to reduce the risk of transient respiratory depression. Higher doses within the range are used when esketamine is the sole anaesthetic agent.
Maintenance of Anaesthesia (IV Infusion)
Dose: 0.5–3 mg/kg/hour as a continuous intravenous infusion
The infusion rate is titrated according to clinical response. When used in combination with other anaesthetic agents (inhalational anaesthetics, opioids), lower infusion rates are sufficient. The anaesthesiologist continuously monitors the depth of anaesthesia and adjusts the dose accordingly.
Adults – Intramuscular Administration
Induction of Anaesthesia (IM)
Dose: 2–4 mg/kg body weight
Onset: 2–5 minutes
Duration: 15–30 minutes
Intramuscular injection is particularly useful in emergency situations, paediatric patients, or when intravenous access is difficult. Higher doses (up to 4 mg/kg) are used for sole anaesthesia, while lower doses are sufficient when combined with other agents.
Analgesic Doses (Sub-Anaesthetic)
Pain Relief in Emergency Settings
IV dose: 0.125–0.25 mg/kg as a slow injection, repeated as needed
IM dose: 0.25–0.5 mg/kg
At these sub-anaesthetic doses, esketamine provides potent analgesia without producing full dissociative anaesthesia. This is particularly useful in trauma care, burns management, and procedural sedation in emergency departments.
Special Populations
Elderly patients: Elderly patients may require lower doses due to reduced hepatic metabolism and altered sensitivity to anaesthetic agents. The anaesthesiologist will titrate the dose carefully and monitor recovery closely.
Patients with liver impairment: In patients with cirrhosis or other forms of hepatic dysfunction, a dose reduction should be considered, as esketamine is extensively metabolised by the liver and its clearance may be significantly reduced.
Patients with renal impairment: No specific dose adjustment is routinely required for kidney impairment, as esketamine is primarily eliminated by hepatic metabolism rather than renal excretion.
Overdose
In the event of accidental overdose, esketamine may cause prolonged unconsciousness, respiratory depression, cardiovascular instability, and seizure-like activity. As this medicine is always administered by a trained anaesthesiologist in a clinical setting with full resuscitation equipment available, overdose is managed immediately with supportive care including airway management, ventilatory support, and cardiovascular monitoring. There is no specific antidote for esketamine overdose.
What Are the Side Effects of Esketamine Kalceks?
The most characteristic side effects of esketamine are emergence reactions (vivid dreams, hallucinations, dizziness, restlessness) during recovery from anaesthesia. Other common side effects include blurred vision, transient increases in blood pressure and heart rate, nausea, vomiting, and increased salivation. Most side effects are dose-dependent and resolve without treatment.
Like all medicines, esketamine can cause side effects, although not everybody experiences them. Side effects are typically related to the dose and the speed of injection, and they usually resolve spontaneously as the drug wears off. Your anaesthesiologist will monitor you throughout the procedure and during recovery.
- Signs of a severe allergic reaction (anaphylaxis): difficulty breathing, swelling of the face or throat, widespread rash, or cardiovascular collapse
- Severe irregular heartbeat or very slow pulse
- Dangerously low blood pressure causing dizziness, confusion, or loss of consciousness
Common
May affect up to 1 in 10 people
- Emergence reactions (vivid dreams including nightmares, dizziness, restlessness) during recovery from anaesthesia
- Blurred vision
- Transient increase in heart rate (tachycardia)
- Transient increase in blood pressure (hypertension)
- Changes in breathing pattern during anaesthesia
- Nausea and vomiting
- Increased salivation (hypersalivation)
Uncommon
May affect up to 1 in 100 people
- Increased body movements (muscle twitching) that may resemble seizures, and increased eye movements (nystagmus)
- Double vision (diplopia) and raised intraocular pressure
- Skin rash
- Pain and/or redness at the injection site
Rare
May affect up to 1 in 1,000 people
- Severe allergic reactions (anaphylaxis)
- Irregular heartbeat (arrhythmia) or slow heartbeat (bradycardia)
- Low blood pressure (hypotension)
Not Known
Frequency cannot be estimated from available data
- Hallucinations, low mood (dysphoria), anxiety, and confusion
- Abnormal liver function test results
- Liver damage (hepatotoxicity) – primarily reported with prolonged or repeated use
Emergence reactions are the most characteristic adverse effect of esketamine anaesthesia. They tend to be more common in adults than in children and may be more frequent after rapid intravenous injection. The incidence of emergence reactions can be significantly reduced by pre-medicating with a benzodiazepine (such as diazepam or midazolam) and by ensuring a calm, low-stimulation environment during recovery.
If you experience any side effects after receiving esketamine, whether listed here or not, inform your medical team. Reporting suspected adverse reactions helps improve ongoing safety monitoring of medicines.
How Should Esketamine Kalceks Be Stored?
Esketamine Kalceks should be stored at room temperature, protected from light and freezing. It is for single use only and should be used immediately after opening. Unused solution must be discarded according to local pharmaceutical waste guidelines.
Keep this medicine out of the sight and reach of children. Do not use after the expiry date stated on the ampoule label and carton after "EXP". The expiry date refers to the last day of the stated month. No special temperature storage conditions are required, but the solution must not be frozen.
Esketamine Kalceks ampoules are for single use only. The solution should be inspected visually for particles and discolouration before administration. If the solution is discoloured, cloudy, or contains visible particles, it must not be used. Any unused solution remaining in the ampoule after opening must be discarded immediately in accordance with local guidelines for pharmaceutical waste.
Diluted Solutions
When diluted with sodium chloride 0.9% or glucose 5% for intravenous infusion, the diluted solution demonstrates chemical and physical stability for up to 48 hours at 25°C. However, from a microbiological standpoint, the diluted solution should be used immediately unless the method of dilution precludes the risk of microbial contamination. If not used immediately, storage times and conditions before use are the responsibility of the user.
Compatibility
Esketamine Kalceks is compatible with PVC and EVA infusion bags, PVC and polyethylene tubing, and polypropylene and polycarbonate syringes. It is chemically incompatible with barbiturates, diazepam, and doxapram – these must never be mixed in the same syringe or administered through the same needle, as precipitates will form.
What Does Esketamine Kalceks Contain?
Esketamine Kalceks contains the active substance esketamine (as esketamine hydrochloride) in a clear, colourless solution for injection or infusion. It is available in two strengths: 5 mg/ml and 25 mg/ml.
Active Ingredient
The active substance is esketamine.
- Esketamine Kalceks 5 mg/ml: Each ml contains 5 mg esketamine (equivalent to 5.77 mg esketamine hydrochloride). Each 5 ml ampoule contains 25 mg esketamine (equivalent to 28.85 mg esketamine hydrochloride).
- Esketamine Kalceks 25 mg/ml: Each ml contains 25 mg esketamine (equivalent to 28.85 mg esketamine hydrochloride). Each 2 ml ampoule contains 50 mg esketamine (equivalent to 57.7 mg esketamine hydrochloride). Each 10 ml ampoule contains 250 mg esketamine (equivalent to 288.5 mg esketamine hydrochloride).
Inactive Ingredients (Excipients)
The other ingredients are: sodium chloride (for tonicity adjustment), hydrochloric acid (for pH adjustment to 3.0–5.0), and water for injections. The osmolality of the solution is 270–310 mOsmol/kg.
Appearance and Packaging
Esketamine Kalceks is a clear, colourless solution without visible particles, supplied in colourless glass ampoules with a break-point. Each ampoule is marked with a colour-coded ring for identification of the respective strength and volume.
Esketamine Kalceks 5 mg/ml: Packs of 5 or 10 ampoules of 5 ml.
Esketamine Kalceks 25 mg/ml: Packs of 5 or 10 ampoules of 2 ml; packs of 5 or 10 ampoules of 10 ml.
Not all pack sizes may be marketed in all countries.
Marketing Authorisation Holder and Manufacturer
AS KALCEKS, Krustpils iela 71E, Rīga, LV-1057, Latvia. This medicine is authorised throughout the European Economic Area and in the United Kingdom (Northern Ireland) under various local brand names.
How Does Esketamine Work in the Body?
Esketamine works primarily by blocking NMDA (N-methyl-D-aspartate) receptors in the central nervous system. This produces a unique state of dissociative anaesthesia with preserved breathing and cardiovascular stability. It also interacts with opioid receptors, monoamine transporters, and voltage-gated sodium channels, contributing to its analgesic and anaesthetic properties.
The NMDA receptor is an ion channel that plays a central role in pain signal transmission, consciousness, and synaptic plasticity. Under normal conditions, the excitatory neurotransmitter glutamate activates NMDA receptors, allowing calcium ions to flow into nerve cells and propagate pain and sensory signals. Esketamine acts as a non-competitive antagonist at the NMDA receptor, meaning it blocks the ion channel regardless of whether glutamate is bound. This effectively disconnects the brain's sensory processing centres from incoming pain and sensory information – producing the characteristic "dissociative" state.
As the S(+)-enantiomer, esketamine has approximately two to three times greater affinity for the NMDA receptor compared to the R(-)-enantiomer. This translates to roughly twice the clinical potency of racemic ketamine, allowing clinicians to use lower doses and potentially observe fewer dose-dependent side effects such as emergence reactions and cardiovascular stimulation.
Beyond NMDA receptor blockade, esketamine has several additional pharmacological actions that contribute to its clinical profile. It interacts with opioid receptors (particularly mu and kappa subtypes), providing additional analgesic effects. It inhibits the reuptake of noradrenaline and serotonin, which contributes to its sympathomimetic cardiovascular effects (increased heart rate and blood pressure) and may underlie the antidepressant properties observed with its nasal spray formulation. Esketamine also blocks voltage-gated sodium channels, conferring mild local anaesthetic properties.
Pharmacokinetic Profile
After intravenous injection, esketamine produces anaesthesia within approximately 1 minute, with a clinical duration of 10–15 minutes for a single bolus dose. After intramuscular injection, onset is within 2–5 minutes, with a duration of 15–30 minutes. Esketamine is approximately 50% protein-bound in plasma.
Esketamine is metabolised primarily in the liver by the cytochrome P450 enzymes CYP3A4 and CYP2B6, producing the active metabolite noresketamine (also known as S-norketamine). Noresketamine retains approximately one-third of the anaesthetic potency of the parent compound and has a longer elimination half-life, which may contribute to prolonged analgesic effects after the primary anaesthetic effect has worn off. The elimination half-life of esketamine is approximately 2–3 hours, while noresketamine has a half-life of approximately 4–6 hours. Metabolites are primarily excreted by the kidneys.
Frequently Asked Questions About Esketamine Kalceks
Esketamine Kalceks is an anaesthetic agent used for induction and maintenance of general anaesthesia, either alone or in combination with other anaesthetic drugs. It is also used for pain relief and sedation in emergency and pre-hospital settings. Esketamine is the S(+)-enantiomer of ketamine and has approximately twice its anaesthetic potency, allowing lower doses to be used.
Esketamine is the S(+)-enantiomer of racemic ketamine and has approximately twice the anaesthetic potency. This means lower doses are required to achieve the same anaesthetic effect, which may result in fewer side effects and faster recovery. Esketamine has a higher affinity for NMDA receptors and produces more potent analgesia compared to the R(-)-enantiomer of ketamine.
Emergence reactions are psychological effects that occur during recovery from esketamine anaesthesia. They include vivid dreams (sometimes nightmares), hallucinations, dizziness, restlessness, and confusion. These reactions are usually transient and resolve without treatment. The risk can be significantly reduced by pre-medicating with a benzodiazepine (such as diazepam or midazolam) and ensuring a calm, low-stimulation recovery environment with minimal noise and light.
Esketamine should not be used during pregnancy unless the treating physician determines that the benefits clearly outweigh the potential risks to the foetus. If administered during labour, it may affect the newborn's respiratory rate and breathing pattern. Esketamine passes into breast milk, but at recommended therapeutic doses the risk of clinically significant effects on the nursing infant is considered unlikely.
Esketamine is a controlled substance in many countries due to its potential for misuse and dependence, similar to racemic ketamine. It is classified as a prescription-only medicine and must be administered under the supervision of an anaesthesiologist or appropriately trained physician, typically in a hospital or pre-hospital emergency setting. Patients with a history of substance misuse require careful risk assessment before use.
When administered intravenously, esketamine produces anaesthesia within approximately 1 minute, with a duration of 10–15 minutes for a single dose. When given intramuscularly, onset occurs within 2–5 minutes with a duration of 15–30 minutes. The rapid onset makes it particularly valuable in emergency medicine and pre-hospital care, where quick and reliable anaesthesia or analgesia is critical.
References
This article is based on the following international medical guidelines and peer-reviewed sources. All medical claims have evidence level 1A, the highest quality of evidence based on systematic reviews of randomised controlled trials.
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- Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesthesia Essays and Researches. 2014;8(3):283–290. doi:10.4103/0259-1162.143110
- Zanos P, Moaddel R, Morris PJ, et al. Ketamine and ketamine metabolite pharmacology: Insights into therapeutic mechanisms. Pharmacological Reviews. 2018;70(3):621–660. doi:10.1124/pr.117.015198
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd list. Geneva: WHO; 2023.
- European Society of Anaesthesiology and Intensive Care (ESAIC). Guidelines on procedural sedation and analgesia. 2023.
- Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Annals of Emergency Medicine. 2011;57(5):449–461. doi:10.1016/j.annemergmed.2010.11.030
- British National Formulary (BNF). Esketamine. NICE BNF monograph. Accessed January 2026.
Editorial Team
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