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Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The most commonly recognized side effects of ketamine include hyper-salivation which is readily treated with glycopyrrolate, and vivid hallucinations. These often occur on emergence from ketamine sedation and are precipitated by noise, movement and bright lights. Co-administration of a small dose of the benzodiazepine midazolam will reduce this effect which is less common in children.
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Ketamine is widely used to provide anesthesia and analgesia in out-of-hospital settings and in some low- and middle-income countries, but it is also commonly used in the management of pain. The doses given will vary according to the indication for the medicine.
Ketamine Use in Pain Management
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Sahar Swidan, Charles E. Schultz
Traditionally, ketamine is administered as intravenous or intramuscular. However, alternative routes have become more widespread including oral, nasal, transdermal, subcutaneous, and rectal administration.2 The dosages and dose ranges provided below are based on published studies and consensus guidelines. Levels of evidence for dose ranges are per consensus guidelines and in accordance with the U.S. Preventive Services Task Force grading of evidence. Levels of evidence are based on the magnitude and certainty of benefit.
Oral ketamine for depression: An updated systematic review
Published in The World Journal of Biological Psychiatry, 2023
Shakila Meshkat, Sipan Haikazian, Joshua D. Di Vincenzo, Farhan Fancy, Danica Johnson, David Chen-Li, Roger S. McIntyre, Rodrigo Mansur, Joshua D. Rosenblat
There are some safety concerns and adverse effects that should be considered while using ketamine for a prolonged period of time. Ketamine raises issues that require careful monitoring, such as the possibility of misuse. Although our review did not find these issues to be significant in the included studies, they may become much more of a concern if ketamine were to be used more often in clinical settings, especially on an outpatient basis (Schoevers et al. 2016). The antidepressant and anti-suicidal effect of ketamine is hypothesised to be mediated by procognitive mechanisms that target executive function and cognitive emotional processing neural circuits (Lee et al. 2016). Therefore, long-term (not short term (of 4 weeks)) and high doses of ketamine can lead to cognitive impairment (Zhang and Ho 2016). Furthermore, ketamine/esketamine administration in individuals with suicidal ideations developed several key issues and unresolved questions. Relapse rate after stopping esketamine is estimated to be 40% within 3–4 months (Bartoli and Wlkinson 2020). Moreover, relapse after esketamine can result in suicide deaths which are explained to be due to withdrawal reaction (Schatzberg 2019).
Perspectives on the pharmacological management of complex regional pain syndrome
Published in Expert Opinion on Pharmacotherapy, 2023
Kyle F. Norton, Timothy J. Furnish
Ketamine infusions have been shown to provide significant analgesia in patients with CRPS. The studied regimens administered ketamine as an infusion in the range of 0.25–0.35 mg/kg/hr as either an outpatient for 4 hours repeated several days in a row, or as an inpatient with continuous infusion for several days in a row. Unfortunately, the therapeutic effects of ketamine infusions are short-lived – up to 12 weeks. Given the need for a multi-day series of infusions and the often out-of-pocket costs, they may be an option for acute flares of pain or for those with the means to pay for repeated infusions. Additionally, the lack of safety data for chronic or long-term use of ketamine and potential for toxicity are an issue. Weaker NMDA antagonists such as dextromethorphan, memantine and amantadine have not been studied specifically in CRPS but have shown mixed analgesic effects in other neuropathic pain conditions.
Past-Year Ketamine Use: Evidence from a United States Population, 2015-2019
Published in Journal of Psychoactive Drugs, 2023
Introduced in 1962, ketamine is a human anesthetic in the medical and behavioral health community that antagonizes N-methyl-D-aspartic acid receptors (Correll et al. 2004; Domino, Chodoff, and Corssen 1965) and currently has approved uses for treating pain, depression, headache, and post-traumatic stress disorder (Frost 2019). Deemed as an essential medicine, the World Health Organization (WHO) has proposed that the Drug Enforcement Agency (DEA) remove ketamine’s schedule III status and not be controlled under international drug laws, due to its necessity in surgical and medical procedures (World Health Organization 2016). Notwithstanding its status as a controlled III substance by the DEA, there has been a renewed interest in ketamine for several severe psychiatric disorders (e.g., depression) and substance use dependence (Jones et al. 2018; Wilkinson et al. 2017). A recent review of the literature found an efficacious role of ketamine in treating opioid and alcohol use disorders, specifically (Jones et al. 2018).