lunes, 16 de marzo de 2015

Ketamina

Curso CEEA en Veracruzcurso CEEA Veracruz
 
Módulo II en Veracruz

CIRCULATORIO. ANESTESIA CARDIOVASCULAR

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Del 17 al 19 de abril de 2015

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La ketamina es un viejo fármaco antagonista no competitivo del receptor de N-metil-D-aspartato. Se ha utilizado ampliamente en la anestesia y el tratamiento del dolor. Descubierta en los años 60, se ha administrado a través de la vías intramuscular, subcutánea, oral, rectal, sublingual, intranasal, epidural, espinal y caudales. La ketamina mejora el dolor postoperatorio y el dolor postraumático, reduce el consumo de opiáceos, previene el dolor crónico postoperatorio. Tiene indicación especial para pacientes con tolerancia a opioides, hiperalgesia aguda, y el dolor neuropático. También tiene un papel en el tratamiento del dolor crónico y la depresión. El uso recreativo ilegal de ketamina está aumentando a través de diferentes vías de administración como intranasal, inhalación, el tabaquismo o la inyección intravenosa. El uso prolongado de esta droga puede conducir a efectos secundarios perjudiciales. Le enviaremos algunos artículos interesantes sobre este fármaco.

The old drug ketamine is a noncompetitive antagonist of N-methyl-d-aspartate receptor. It has been extensively used in anesthesia and pain management. Discovered in the 60s, it has been administered via the intravenous, intramuscular, subcutaneous, oral, rectal, topical, intranasal, sublingual, epidural, spinal, and caudal routes. Ketamine improves postoperative and posttrauma pain, reduces opioid consumption, prevent chronic postoperative pain. It has special indication for patients with opioid tolerance, acute hyperalgesia, and neuropathic pain. It also has a role in the management of chronic pain and depression. Illegal recreational use of ketamine is rising through different routes of administration like intranasal, inhalation, smoking, or intravenous injection. Prolonged use of this drug may conduct to deleterious side effects. You will get some interesting articles about this drug.
Morfina con ketamina como adyuvante versus dosis altas de morfina para dolor agudo. Meta-análisis
Morphine with adjuvant ketamine versus higher dose of morphine alone for acute pain: a meta-analysis. Ding X, Jin S, Niu X, Wang T, Zhao X, Ren H, Tong Y, Li Q. Int J Clin Exp Med. 2014 Sep 15;7(9):2504-10. eCollection 2014.
Abstract
PURPOSE: Ketamine is currently the N-methyl-D-aspartate receptor channel blocker in clinical use. Morphine in pain management is usually limited by adverse effect such as nausea and vomiting. Adjuvant treatment with ketamine may be value in giving better analgesia with fewer adverse effects. The purpose of this meta-analysis was to evaluate the differences when patients received morphine with adjuvant ketamine (MK) compared with higher dose of morphine (MO) for acute pain. METHODS: The PubMed, EMBASE and the Cochrane Library databases were searched (Last search performed on July 1, 2014) by two reviewers independently. Data were extracted independently by the same two individuals who searched the studies. RESULTS: A total of 7 trials involving 492 patients were included in the current analysis. We found pain scores were lower in the MK group compared to the MO group [MD 2.19, 95% CI (1.24, 3.13) P<0.00001]. And more patients in the MO required diclofenac [OR 1.97, 95% CI (1.06, 3.67) P=0.03]. Furthermore, morphine plus ketamine can reduced post-operative nausea and vomiting (PONV) [OR 3.71, 95% CI (2.37, 5.80) P<0.00001]. Importantly, the wakefulness scores for the MK group were consistently and significantly better than those for the MO group [MD -1.53, 95% CI (-2.67, -0.40) P=0.008]. CONCLUSION: The use of ketamine plus 1/4~2/3 the dose of morphine is better than higher dose of morphine alone in reducing pain scores, and rescuing analgesic requirement. It also improved PONV and wakefulness.
KEYWORDS: Morphine; acute pain; ketamine; meta-analysis
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Efectos en dolor postoperatorio de la ketamina i.v. en analgesia controlada por pacientes adictos al opio
Effect of intravenous patient controlled ketamine analgesia on postoperative pain in opium abusers.
Dahi-Taleghani M1, Fazli B1, Ghasemi M1, Vosoughian M1, Dabbagh A1.
Anesth Pain Med. 2014 Feb 15;4(1):e14129. doi: 10.5812/aapm.14129. eCollection 2014.
Abstract
BACKGROUND: Acutepostoperative pain is among the worst experience that patient scan undergo, and many analgesics have been used to suppress it; especially in chronic opium abusers. Ketamine is an N-methyl-D-aspartate antagonist analgesic, having both anesthetic and analgesic properties, which are not affected to the same extent in chronic opium abusers. OBJECTIVES: In this study, we assessed the analgesic effects of ketamine added to morphine as a patient-controlled analgesia method for acute pain management, compared with a placebo, inchronic maleopium abusers. PATIENTS AND METHODS: After institutional review board approval for ethical considerations, a randomized double-blinded placebo controlled clinical trial was conducted. A total of 140 male patients aged 18-65 years, undergoing orthopedic surgery, were entered into the study after matching inclusion and exclusion criteria. All patients received the same anesthesia method; while the first group received ketamine (1mg/mL) and morphine (0.5 mg/mL) as a patient-controlled analgesia (70 patients), the second group received morphine (0.5 mg/mL) plus normal saline (70 patients). P value less than 0.05 was considered statistically significant. RESULTS: The ketamine and morphine group of patients experienced less postoperative pain and required less postoperative rescue analgesia. However, the unwanted postoperative side effects were nearly the same; although increased levels of postoperative nausea and vomiting were observed in the ketamine and morphine group. CONCLUSIONS: This study demonstrated improved analgesic effects after using intravenous patient controlled analgesia with ketamine on postoperative pain in opium abusers.
KEYWORDS: Acute Pain; Drug Users; Ketamine; Opium
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Anestesia y Medicina del Dolor
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