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Special K sin licencia para matar: sobredosis accidental de ketamina en la inducción de anestesia general.
Special K with No License to Kill: Accidental Ketamine Overdose on Induction of General Anesthesia.
Abstract
BACKGROUND. Ketamine is used as an induction and sedation agent in emergency departments and operating rooms throughout the country. Despite its widespread clinical use, there are few cases of significant morbidity and mortality attributed to ketamine overdose in the clinical setting. CASE REPORT; The anesthesia provider in the room was an oral maxillofacial surgeon who inadvertently took out a more highly concentrated bottle of ketamine that is typically used for pediatric patients. The patient received 950 mg (100 mg/ml concentration) of intravenous ketamine instead of the intended 95 mg (10 mg/ml concentration). After the ketamine was given, there were no signs to any involved provider that a mistake had occurred until the wake-up appeared to be unusually prolonged. CONCLUSIONS; Despite this, the patient did not demonstrate any systemic effects such as hemodynamic or CNS perturbations other than prolonged awakening. This case highlights one (drug overdose) of many causes of delayed emergence from anesthesia and reminds the provider caring for the patient to be mindful of drug concentrations used when preparing to sedate a patient, as relying on effects of the parent drug is not always adequate.
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Experiencia en el uso de ketamina para controlar la abstinencia de opiáceos en una mujer adicta: informe de un caso.
Experience of the use of Ketamine to manage opioid withdrawal in an addicted woman: a case report.
Abstract
BACKGROUND: Opioids are good painkillers, but many patients treated with opioids as painkillers developed a secondary addiction. These patients need to stop misusing opioids, but the mild-to-severe clinical symptoms associated with opioid withdrawal risk increasing their existing pain. In such cases, ketamine, which is used by anaesthetists and pain physicians to reduce opioid medication, may be an effective agent for managing opioid withdrawal. CASE PRESENTATION: We describe the case of a woman who developed a severe secondary addiction to opioids in the context of lombo-sciatic pain. She presented a severe opioid addiction, and her physicians refused to prescribe such high doses of opioid treatment (oxycontin® extended-release 120 mg daily, oxycodone 60 mg daily, and acetaminophen/codeine 300 mg/25 mg 6 times per day). To assist her with her opioid withdrawal which risked increasing her existing pain, she received 1 mg/kg ketamine oral solution, and two days after ketamine initiation her opioid treatment was gradually reduced. The patient dramatically reduced the dosage of opioid painkillers and ketamine was withdrawn without any withdrawal symptoms. CONCLUSION: Ketamine displays many interesting qualities for dealing with all symptoms relating to opioid withdrawal. Accordingly, it could be used instead of many psychotropic treatments, which interact with each other, to help with opioid withdrawal. However, the literature describes addiction to ketamine. All in all, although potentially addictive, ketamine could be a good candidate for the pharmacological management of opioid withdrawal.
KEYWORDS: Ketamine; Opioid addiction; Opioid withdrawal; Painkillers
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Tratamiento exitoso del prurito asociado al nevo epidérmico con ketamina-amitriptilina-lidocaína tópicas.
Successful Treatment of Epidermal Nevus-associated Pruritus with Topical Ketamine-Amitriptyline-Lidocaine.
Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare, linear, unilateral, pruritic eruption that usually presents during childhood. It is more commonly seen on an extremity, although cases on the head and neck area have been reported in the past (1). It is considered a variant of keratinocytic epidermal nevus; however, it has a significant histological similarity with psoriasis. Patients who have this condition usually complain of intense pruritus (2). Treatments that are regularly effective in psoriasis have shown low efficacy on the management of these lesions, as well as their related symptoms (3). We present here a case of successful treatment of pruritus associated with an epidermal nevus with the use of topical Ketamine 10% - Amitriptyline 5% - Lidocaine 5% in lipoderm base (TKAL). The preparation is widely used in the US for nociceptive pain and is prepared by a compounding pharmacy. All ingredients are FDA approved
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Combinación de ketamina/bupivacaína tópica versus caudal para la analgesia postoperatoria en niños sometidos a herniotomía inguinal.
Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy.
Abstract
BACKGROUND: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. PATIENTS AND METHODS: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topicalgroup). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. RESULTS: Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. CONCLUSION: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.
KEYWORDS: Analgesia; caudal; day-case anesthetic techniques; ketamine; pediatrics; postoperative; topical
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Modulación de la Actividad del Receptor NMDA en la Fibromialgia.
Modulation of NMDA Receptor Activity in Fibromyalgia.
Biomedicines. 2017 Apr 11;5(2). pii: E15. doi: 10.3390/biomedicines5020015.
Abstract
Activation of the N-methyl-d-aspartate receptor (NMDAR) results in increased sensitivity of spinal cord and brain pathways that process sensory information, particularly those which relate to pain. The NMDAR shows increased activity in fibromyalgia and hence modulation of the NMDAR is a target for therapeutic intervention. A literature review of interventions impacting on the NMDAR shows a number of drugs to be active on the NMDAR mechanism in fibromyalgia patients, with variable clinical effects. Low-dose intravenous ketamine and oral memantine both show clinically useful benefit in fibromyalgia. However, consideration of side-effects, logistics and cost need to be factored into management decisions regarding use of these drugs in this clinical setting. Overall benefits with current NMDAR antagonists appear modest and there is a need for better strategy trials to clarify optimal dose schedules and to delineate potential longer-term adverse events. Further investigation of the role of the NMDAR in fibromyalgia and the effect of other molecules that modulate this receptor appear important to enhance treatment targets in fibromyalgia.
KEYWORDS: NMDA receptor; drugs; fibromyalgia; ketamine; memantine
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La ketamina en el tratamiento del dolor crónico según medicina basada en la evidencia
F. Neira Reina y J. L. Ortega García
Rev Soc Esp Dolor 2016; 23(6): 292-306.
Resumen:
La ketamina es un antagonista no competitivo de los receptores NMDA y tiene un amplio mecanismo de acción que involucra, además, a los receptores AMPA, kainato, ácido gamma-aminobutírico, opioides, monoaminérgicos, muscarínicos y nicotínicos. Actúa sobre los canales de calcio y sodio voltaje-dependientes, interviene en la síntesis y liberación del óxido nítrico e inhibe la recaptación de serotonina. La interacción con todos estos mecanismos de acción hace que tenga una importante participación sobre mecanismos del dolor, inflamación, neuroprotección y tolerancia de opioides ....
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Delivering safe anaesthesia to the world's poorest people
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