Ketamine Use for Palliative Care in the Austere Environment: Is Ketamine the Path Forward for Palliative Care.
John R Reed, Stephanie K Parks, Antony Kaniaru, Justin Hefley, Young Yauger, Jeremy V Edwards, Derrick Glymph
The American journal of hospice & palliative care March 1, 2025 DOI: 10.1177/10499091241246520 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Ketamine End-of-life distress Esketamine |
| Keywords | Combat care Pain management Palliative care Suffering Combat medicine Austere medicine Ketamine therapy |
| Citations | 1 |
| Key findings | Ketamine is an attractive consideration for palliative care in austere military environments to provide sedation and pain management for critically wounded patients during prolonged medical management. |
Abstract
The goal of palliative care is to focus on the holistic needs of the patient and their family versus the pathology of the patient's diagnosis to reduce the stress of illness. U.S. servicemembers deployed to austere environments worldwide have significantly less access to palliative care than in military treatment facilities in the U.S. Preparation for future conflicts introduces the concept of prolonged medical management for an environment where urgent casualty evacuation is impossible. Ketamine is currently widely used for analgesia and anesthesia in the care of military service members and its use has increased in combat zones of Iraq and Afghanistan due to the favorable preservation of respiratory function, minimal changes in hemodynamics, and lower pain scores compared to opioids. Ketamine acts as a non-competitive antagonist on N-methyl-D aspartate (NMDA) receptors. Its anesthesia and analgesic effects are complex and include both presynaptic and postsynaptic neurons in brain and spinal cord. The use of palliative care to minimize suffering should not be withheld due to the logistical boundaries of austere military environments or lack of guidelines for recommended use. The use of ketamine for palliative care is a new clinical management strategy to provide both sedation and pain management for an acute pain crisis or comfort measures for the terminally ill. This makes ketamine an attractive consideration for palliative care when managing critically wounded patients for an extended time.
Comparable studies
Other narrative reviews on end-of-life distress, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Top Ten Tips Palliative Care Clinicians Should Know About Psychedelic-Assisted Therapy in the Context of Serious Illness. Palliative care clinicians and patients | 2022 | Review | |
| The Potential of Psychedelics for End of Life and Palliative Care. Patients with life-threatening diagnoses | 2022 | Review | |
| Psilocybin in Palliative Care: An Update. Palliative care patients | 2023 | Review | |
| Psychedelic medicines for end-of-life care: Pipeline clinical trial review 2022. People with terminal illnesses experiencing depression, anxiety, or existential distress | 2023 | Scoping review | n = 25 |
| Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application—a review | 2024 | Narrative review |
Citations in the library
Cites 3
- Ketamine: a paradigm shift for depression research and treatment Neuron March 1, 2019
- Low-dose S-ketamine exerts antidepressant-like effects via enhanced hippocampal synaptic plasticity in postpartum depression rats. Neurobiology of Stress 2022
- Ketamine, benzoate, and sarcosine for treating depression. Neuropharmacology February 1, 2023