Ketamine in neurosurgery: a historical perspective

Ketamine, a short-acting anesthetic first synthesized in 1962, has long been surrounded by controversy, particularly regarding its use in neurosurgery. The rise in elective surgeries in the early 20th century spurred the development of new anesthetics. Phencyclidine (PCP) was created, which was effective but caused psychotic features. In response, ketamine, a safer PCP derivative was synthesized. Approved by the FDA in 1970, ketamine was widely used during the Vietnam War and gained favor in pediatric neurosurgery due to its rapid onset, lack of intubation requirement, and smooth recovery. It introduced the concept of "dissociative anesthesia." However, the emergence of newer anesthetics, early concerns about ketamine raising intracranial pressure (ICP), and its association with recreational drug use led to a decline in clinical neurosurgical use. This study explores ketamine's history, misconceptions about its safety, its effects on ICP, and its current neurosurgical applications. Reevaluating ketamine's history and its role could improve outcomes in neurological critical care and lead to a greater awareness that is essential to understanding its potential in neurosurgery.