Ketamine

We read with great interest the article by Escolas et al1 evaluating the postdischarge cause-of-death of combat-related burn patients. They report that combat operations in Iraq and Afghanistan have resulted in up to 8.8% of combat-related casualties suffering burns with an overall case fatality rate of 1.3%, which is less than the 4% observed from World War I through Desert Storm. The authors suggest that combat burn injury did not appear to increase the risk of death by suicide. They discuss, as factors that may partially explain this low incidence, close support from multidisciplinary burn teams, social, and family support. We totally agree with this and propose that some medications like ketamine (K) may be an additional factor for reducing the risk of post-traumatic stress disorder (PTSD) and suicide. K has been widely used in anesthesia for many years and in various environments2 and can be used to induce anesthesia, sedation, analgesia, and amnesia. Main advantage is to preserve functional residual capacity, induce bronchodilation, and avoid cardiovascular depression.3 K is very popular among military anesthesiologist for rapid sequence induction, maintenance of anesthesia, or pain control.4 It also offers a useful option to the combat medic's options for battlefield pain management.5 It appears that burned casualties studied by Escolas et al were likely to be treated with K which seems to be the most commonly used analgesic drug for prehospital and en route use in the combat setting.6 Since K is associated with psychosomatic effects, there is possible concern that ketamine may increase the risk of developing PTSD. Contrary to expectations, this is not the case.7 Not only K do not increase the risk of PTSD but is currently being investigated as a novel therapeutic for depression and suicidality.8 It is proposed that K has potential for treatment of major depression associated with PTSD in combat veterans.9 Ketamine is also effective after a single injection for rapid conversion of suicidal to nonsuicidal intentional thought processes in patients presenting to the emergency department.10 Despite further studies are warranted, we think that controlled use of ketamine may play, in combination with social an family network, a central role in preventing suicide in combat veterans.