The acute and residual effects of escalating, analgesic-range doses of ketamine on driving performance: A simulator study.
Amie C Hayley, Maja Green, Luke A. Downey, Con Stough, Michael Keane, Brook Shiferaw, Panagiota Kostakis, Yahya Shehabi
Progress in Neuro-Psychopharmacology and Biological Psychiatry August 30, 2018 DOI: 10.1016/j.pnpbp.2018.05.015 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Open label, within-subjects dose-escalation study Open-label Peer reviewed |
|---|---|
| Sample size | 20 |
| Population | 15 males and 5 females, mean age 30.8 years |
| Intervention | Ketamine |
| Dose | 8 mg/h IV infusion plus 30 mg bolus, 12 mg/h IV infusion, 20 mg/h IV infusion |
| Duration | Three stepwise treatment steps with assessment at 2 h post-infusion |
| Measures | Standard Deviation of Lateral Position (SDLP), Steering Variability (SV) |
| Topics | Ketamine Esketamine |
| Keywords | Accident Driving Risk Sdlp |
| Key points | Ketamine significantly worsened simulated driving performance, with SDLP increasing at each of three stepwise doses (all p<0.001 versus baseline) and steering variability increasing at the 12 mg/h step (p=0.049). At the highest dose, SDLP changes were considered incompatible with safe driving. Performance returned to baseline 2 hours post-infusion, and weak positive associations were seen between SDLP and whole blood ketamine (R2=0.11) and norketamine (R2=0.09) concentrations. |
Abstract
Ketamine hydrochloride elicits potent psychotomimetic and neurobehavioural effects which make it incompatible with driving; however, the direct effect on driving performance is yet to be assessed. Using an open label, within-subjects protocol, 15 males and 5 females (mean age = 30.8 years) were administered three fixed, stepwise increasing sub-anaesthetic doses of intravenous (IV) ketamine solution [(i) 8 mg/h IV infusion plus 30 mg bolus, (ii) 12 mg/h IV infusion and (iii) 20 mg/h infusion]. Whole blood ketamine and norketamine concentrations were determined at each treatment step and at 2 h post-infusion. Driving performance was assessed at baseline, at each treatment step and at 2 h post-treatment using a validated computerised driving simulator. Standard Deviation of Lateral Position (SDLP) and Steering Variability (SV) were assessed. Linear Fixed Effect Modelling indicated a main effect for time (dose) for SDLP (F[4,72] = 33.22, p < 0.0001) and SV (F[4,72] = 4.65, p < 0.002). Post-hoc analyses revealed significant differences from baseline at each treatment step for SDLP (all p < 0.001), and for 12 mg/h treatment step for SV (p = 0.049). Post-treatment driving performance returned to baseline levels. Weak positive linear associations were observed between SDLP and whole blood ketamine concentrations (R2 = 0.11, β = 29.96, p = 0.001) and norketamine (R2 = 0.09, β = 28.87, p = 0.003). These findings suggest that even under highly controlled conditions, ketamine intoxication significantly alters simulated driving performance. At the highest dose, ketamine produced changes to SDLP considered incompatible with safe driving, highlighting how ketamine consumption may translate to an increased risk of road trauma.
Comparable studies
Other non-randomized and open-label trials on ketamine, most cited first.
Citations in the library
Cites 9
- Subanesthetic Effects of the Noncompetitive NMDA Antagonist, Ketamine, in Humans Archives of General Psychiatry March 1, 1994
- Ketamine Pharmacology: An Update (Pharmacodynamics and Molecular Aspects, Recent Findings) CNS Neuroscience & Therapeutics April 10, 2013
- Ketamine Anesthesia & Analgesia November 1, 1998
- Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes Pain August 1, 1999
- Psychedelic Effects of Ketamine in Healthy Volunteers Anesthesiology 1998
and 4 more in the library