The correlation between ketamine and posttraumatic stress disorder in burned service members
This observational study (n=241) investigated the prevalence of PTSD with respect to perioperative low-dose ketamine use in burned soldiers undergoing surgery. Results indicate that PTSD was less prevalent amongst soldiers who were treated with ketamine, despite having larger burns, higher injury severity score, undergoing more operations, and spending more time in the ICU compared to soldiers who did not receive it as a treatment.
Authors
- Mcghee, L. L.
- Maani, C. V.
- Garza, T. H.
Published
Abstract
Background
Predisposing factors for posttraumatic stress disorder (PTSD) include experiencing a traumatic event, threat of injury or death, and untreated pain. Ketamine, an anesthetic, is used at low doses as part of a multimodal anesthetic regimen. However, since ketamine is associated with psychosomatic effects, there is a concern that ketamine may increase the risk of developing PTSD. This study investigated the prevalence of PTSD in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) service members who were treated for burns in a military treatment center.
Methods
The PTSD Checklist-Military (PCL-M) is a 17-question screening tool for PTSD used by the military. A score of 44 or higher is a positive screen for PTSD. The charts of all OIF/OEF soldiers with burns who completed the PCL-M screening tool (2002-2007) were reviewed to determine the number of surgeries received, the anesthetic regime used, including amounts given, the total body surface area burned, and injury severity score. Morphine equivalent units were calculated using standard dosage conversion factors.
Results
The prevalence of PTSD in patients receiving ketamine during their operation(s) was compared with patients not receiving ketamine. Of the 25,000 soldiers injured in OIF/OEF, United States Army Institute of Surgical Research received 603 burned casualties, of which 241 completed the PCL-M. Of those, 147 soldiers underwent at least one operation. Among 119 patients who received ketamine during surgery and 28 who did not; the prevalence of PTSD was 27% (32 of 119) versus 46% (13 of 28), respectively (p = 0.044).
Conclusions
Contrary to expectations, patients receiving perioperative ketamine had a lower prevalence of PTSD than soldiers receiving no ketamine during their surgeries despite having larger burns, higher injury severity score, undergoing more operations, and spending more time in the ICU.
Research Summary of 'The correlation between ketamine and posttraumatic stress disorder in burned service members'
Introduction
Early reports from Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) describe substantial rates of posttraumatic stress disorder (PTSD) among returning service members, and untreated pain and physical injury have been proposed as contributors to PTSD risk. Ketamine, an anaesthetic with analgesic properties that also produces dissociative and psychotomimetic effects, is used at low doses as part of multimodal perioperative pain management in military burn care. Because of ketamine's psychoactive effects there has been concern that its perioperative use might increase the likelihood of later PTSD. Mcghee and colleagues set out to examine the prevalence of PTSD among OIF/OEF service members treated for thermal injuries at the United States Army Institute of Surgical Research (USAISR) Burn Centre between 2002 and 2007, and to explore whether receiving ketamine during operative procedures was associated with PTSD screening results. The study used the military version of the PTSD Checklist (PCL-M) as the screening instrument and compared patients who did and did not receive intraoperative ketamine, while also investigating the relationship between burn size and PTSD prevalence.
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Study Details
- Study Typeindividual
- Journal
- Compound
- Topics
- APA Citation
McGhee, L. L., Maani, C. V., Garza, T. H., Gaylord, K. M., & Black, I. H. (2008). The correlation between ketamine and posttraumatic stress disorder in burned service members. Journal of Trauma: Injury, Infection & Critical Care, 64(2), S195-S199. https://doi.org/10.1097/TA.0b013e318160ba1d
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