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The Correlation between Ketamine and Posttraumatic Stress Disorder in Burned Service Members
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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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 FreedomOperation Enduring Freedom OIFOEF service members who were treated for burns in a military treatment center. 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 OIFOEF 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. The prevalence of PTSD in patients receiving ketamine during their operations was compared with patients not receiving ketamine. Of the 25,000 soldiers injured in OIFOEF, United States Army Institute of Surgical Research received 603 burn casualties, of which 241 completed the PCL-M. Of those, 147 soldiers underwent at least one operation. Among the 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. 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 scores, undergoing more operations, and spending more time in the ICU.
APPROVED FOR PUBLIC RELEASE