Answers to a Journalist Researching Matthew Perry's Death

A journalist contacted me recently and asked me these questions:

1.     Can ketamine by itself cause respiratory depression?

From the anesthesia book, Miller is considered the Bible of anesthesia. Ketamine produces doses related to unconsciousness and analgesia. This is termed dissociative anesthesia because patients who receive ketamine alone appear to be in a cataleptic state.

Ketamine’s effects on the respiratory system are minimal, and it has actually been found to increase respiratory drive at relative doses. However, a transient one-to-three-minute decrease in ventilation after a bolus that would be used in intraoperative general anesthesia can occur.

It would take unusually high doses to produce apnea, and again, given the levels found in his system, this is very unlikely.

2.     What do you believe is the most likely route of ketamine ingestion, and could it be possible that the coroners may have missed the skin puncture from a ketamine injection?

This is a great question. I think i…