In the 1950s, the pharmaceutical company Parke-Davis researched alternatives to conventional anesthesia. One of the first breakthroughs into the sedative-hypnotic class was phencyclidine, commonly known as PCP.
Animal testing later showcased the desirable anesthetic markers of psychological detachment, muscle relaxation, and temporary paralysis. Despite this, misgivings remained concerning the application of PCP to humans because of its propensity towards inducing erratic delirium. Dramatic descriptions of this state are found in news accounts of people with “superhuman strength,” who are impervious to pain while being psychotically detached or delusional, sometimes paranoid, and predisposed to violence. Indeed, PCP, as a recreational drug, manifested itself as a newsworthy phenomenon in American law enforcement culture. Reports of “deranged” suspects undaunted by the force of several police officers’ attempts to subdue them became fodder for the extremities night news footage.
Because of PCP’s unacceptable incidence of post-procedural behavioral extremes, the revelation of Ketamine’s similar ability to provide anesthetic benefits in the surgical theatre, albeit with fewer and less concerning adverse effects, including delirium, was met with enthusiasm. The FDA officially approved ketamine in 1970.
The timing of its approval, accompanied by the supporting studies detailing dosing and safety thresholds, and a clearer understanding of the safety protocol for handling any problematic side effects, made it a candidate for battlefield use in the Vietnam War. In this environment, Ketamine’s benefits enhanced its reputation for surgical and peri-traumatic indications.
Wounds on the field of battle can be similar to those inflicted in a surgical environment. While ammunition’s aim is to destroy and surgery’s to repair, survival requires mitigation of the same factors.
Hemodynamics – one of the side effects of ketamine is acute hypertension. Elevations in pressure and pulse may be significant. However, in a violent scenario, where wounds are accompanied by blood loss, these hemodynamic “side effects” become a benefit, maintaining blood pressure despite volume loss. Blood loss is also a concern in surgery where anesthetic agents that sustain pressure are preferred.
Analgesia (pain relief) – injury, whether due to malicious wounding or surgical intervention, is accompanied by significant pain. Ketamine’s ability to relieve acute pain is helpful in these scenarios.
Psychological Trauma – During combat, wounds are of both a psychological and medical nature. The trauma of intense injury, the circumstances of overwhelming stress, and accompanying mental, emotional, and physical strain, all be lethal or leave a soldier with permanent injuries of a medical or psychological nature.
In the last decades, high rates of PTSD diagnosis and suicides are a fallout of violent human conflict. Due to surgery’s similar traumatic elements, though well-intentioned, sedative-hypnotics like Ketamine help minimize trauma through interruption of short-term memory and the psychological distancing from full consciousness. Unfortunately, this facet of Ketamine’s function explains its unlawful use as a “date rape” drug.