Does Peritraumatic Ketamine Reduce Symptoms of Post-Traumatic Stress Disorder?

Introduction: Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are chronic diseases which can affect patients following a severe trauma. As these patients typically first present to the emergency department, it is critical for emergency physicians to remain updated on the use of ketamine or other anesthetic agents which may impede development or reduce symptoms which may impair normal functioning. The purpose of this clinical review was is to review the literature regarding how the use of peritraumatic ketamine could decrease the incidence of ASD and PTSD. In 2019, the authors completed a MEDLINE search was performed yielding 25 articles which were initially evaluated by the first and second authors. Four articles which met inclusion criteria are discussed in this manuscript.

Summary of evidence: Although two earlier research groups have found that peritraumatic ketamine administration contributed to increased symptoms of PTSD (e g., reexperiencing, dissociation, avoidance, and hyperarousal), two later studies have indicated that ketamine had no effect on PTSD development. Additionally, one 2012 study group has suggested propofol use may alleviate PTSD symptoms at six months post-trauma. Another 2017 study team found that the number of surgical procedures was directly correlated with increased PTSD development.

Conclusions: Based on the literature to date, peritraumatic ketamine does not appear to influence the prevention nor development of ASD and subsequent PTSD. More research is needed to clarify the psychopharmacologic effects of ketamine when used in the management of reactions to acute trauma experiences. Based on the results of the two later works, future research is indicated considering whether propofol may contribute to PTSD development.