Sofia Peeva, MD Board-Certified Anesthesiologist
According to the CDC more than 300,000 USA citizens die of heart disease each year and more than 20 million of adults in the USA ages 18 and older suffer with coronary artery disease. To add to this statistic there are also the individuals with congenital or acquired heart abnormalities and arrythmias (abnormal heart rhythms).
Ketamine has one of the best safety profiles of all anesthetics. This allows ketamine to be successfully used in many different situations that have the potential for cardiac instability including in the battle field, for general anesthetics, sedations and in stand-alone clinics to treat mental health.
Ketamine, after its approval by the FDA for human use (1970), was initially hailed as a “wonder drug” during the Vietnam war where it was used to quickly anesthetize bleeding solders on the battle field. Ketamine is the medication of choice when dealing with large blood loss traumas such as multiple gunshot and other penetrating wounds. Ketamine is also used to induce anesthesia in patients undergoing cardiac surgeries such as heart valve repair, replacement and coronary artery bypass. Lastly ketamine has a prominent use in pediatric anesthesia.
The reason why ketamine can be used in all of the above scenarios where heart disease and heart strain are a main concern to the anesthetist is because ketamine is very hemodynamically stable, meaning it will not lower the blood pressure when given for anesthesia. By keeping the patient hemodynamically stable the strain on the heart is decreased and therefor risk for adverse cardiac effects is minimized.
Ketamine has also been given in patients with cardiac arrythmias such as atrial fibrillation and flutter successfully.
In the setting of ketamine infusions used to treat PTSD, depression, anxiety and suicidal ideation the dosages of ketamine used are termed “subanesthetic” meaning that they are much lower than what one would expect to receive during a general anesthesia induction. Not only are the doses much lower but they are also delivered over 45-60 mins further lowering the risk of adverse cardiac events.
In conclusion it would be very unusual for ketamine to cause adverse cardiac events to patients with cardiac disease if proper care and preparation is taken and in the subanesthetic doses required to treat mental health disorders.