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Ketamine in neurosurgery: a historical perspective
Allie L Sinclair1, Gabriel Jelkin1, Beatrice Zucca1,2
11Department of Neurological Surgery, University of Cincinnati, Ohio; and.
Journal of Neurosurgery
|July 24, 2026
Summary
Ketamine, an anesthetic, offers benefits in neurosurgery despite historical concerns. Reevaluating its use can improve neurological critical care outcomes.
Area of Science:
- Anesthesiology
- Neurosurgery
- Pharmacology
Background:
- Ketamine, a phencyclidine derivative, was developed as a safer anesthetic with rapid onset and smooth recovery.
- It was favored in pediatric neurosurgery and introduced dissociative anesthesia.
- Concerns about intracranial pressure (ICP) and recreational use led to decreased neurosurgical application.
Purpose of the Study:
- To explore the history of ketamine in neurosurgery.
- To address misconceptions regarding ketamine's safety and its effects on ICP.
- To reevaluate ketamine's current neurosurgical applications and potential.
Main Methods:
- Historical review of ketamine's development and clinical use.
- Analysis of early concerns and misconceptions about ketamine's safety.
- Examination of current evidence on ketamine's effects on intracranial pressure.
- Review of contemporary neurosurgical applications.
Main Results:
- Ketamine was initially favored for pediatric neurosurgery due to its unique anesthetic properties.
- Concerns regarding increased intracranial pressure (ICP) have been a significant factor in its reduced use.
- Misconceptions about ketamine's safety profile persist.
- Current research suggests potential benefits and specific applications in neurosurgery.
Conclusions:
- Revisiting ketamine's history is crucial for understanding its neurosurgical role.
- Addressing safety concerns and misconceptions can clarify its potential in neurological critical care.
- Further evaluation may optimize ketamine's application in modern neurosurgery.
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