Efficacy of intraoperative ketamine in attenuating emergence agitation in patients with sexual trauma-related post-traumatic stress disorder
Janine Stirling, M. Doane, M. Simon, Rita Shackel, James Elliott
Australian and New Zealand Continence Journal August 11, 2026 DOI: 10.1071/cj25013 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Esketamine Ketamine PTSD |
| Key findings | Argues that patients with PTSD, especially survivors of sexual trauma undergoing pelvic-area procedures, may show emergence agitation and pain amplification after general anaesthesia, linked to altered benzodiazepine receptor binding and stress-driven glutamate and cortisol release. Proposes that ketamine could attenuate this response and serve as a protective anaesthetic adjunct, though the text presents this as a hypothesis rather than a tested result. |
Abstract
Post-traumatic stress disorder places patients at risk for emergence agitation following surgical procedures under general anaesthesia. Gynaecological procedures, sphincteroplasty, and surgical interventions involving the pelvic floor can involve vulnerable patient positioning in theatre, with inserted catheters and sensory stimulation. Such interventions could contribute to postoperative emergence agitation, especially in those with prior experiences of adult sexual assault or childhood sexual abuse. In the medial pre-frontal cortex of patients with post-traumatic stress disorder, brain imaging reveals altered benzodiazepine receptor binding, compared to patients without this chronic stress condition. Consequently, some patients with post-traumatic stress disorder have been known to display trauma re-enactments, thrashing movements, emergence agitation and signs of pain amplification in early recovery from anaesthesia. The objective of this narrative review is to explore why this is the case and to determine whether ketamine has potential to be beneficial. Evidence already exists in the field of mental health to support how ketamine can provide transient relief for symptoms of depression, post-traumatic stress disorder, even suicidality. Extreme stress (for example, reactivation of a trauma memory during emergence from anaesthesia) can stimulate the release of glutamate and cortisol. In excess, this combination causes cellular damage and amplifies pain sensitivity. Ketamine may attenuate such a response, potentially offering a promising protective anaesthetic adjunct for survivors of sexual trauma with post-traumatic stress disorder.
Comparable studies
Other narrative reviews on ketamine for PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. | 2024 | Narrative state-of-the-art review | |
| Glutamate and post-traumatic stress disorder: toward a psychobiology of dissociation. | 1999 | Review | |
| The Psychedelic Future of Post-Traumatic Stress Disorder Treatment | 2024 | Comprehensive review | |
| Diverse therapeutic developments for post-traumatic stress disorder (PTSD) indicate common mechanisms of memory modulation. | 2022 | Review | |
| The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence. | 2023 | Review |
Citations in the library
Cites 5
- The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis American Journal of Psychiatry October 3, 2017
- Efficacy of Intravenous Ketamine for Treatment of Chronic Posttraumatic Stress Disorder JAMA Psychiatry April 16, 2014
- A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder. American Journal of Psychiatry January 5, 2021
- Targeting inflammation in depression: Ketamine as an anti-inflammatory antidepressant in psychiatric emergency Brain, Behavior, & Immunity - Health November 1, 2021
- A Review of the Mechanism of Antagonism of N-methyl-D-aspartate Receptor by Ketamine in Treatment-resistant Depression. Cureus May 18, 2018