Ketamina y depresión / Ketamine and depression

Mayo 8, 2016. No. 2320

Ketamina intravenosa para el tratamiento de alteraciones mentales. Intravenous Ketamine for the Treatment of Mental Health Disorders: A Review of Clinical Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2014 Aug.  CADTH Rapid Response Reports. Excerpt Ketamine emerged as a novel treatment for certain mental health disorders in 2000 when Berman et al. published a seven patient RCT of intravenous (IV) ketamine compared to a saline placebo showing a reduction in the Hamilton Depression Rating Scale (Ham-D). This was the first suggestion thatketamine could be a benefit for treating mental health disorder and since previous investigations on treatment of mental health disorders have focused on the monoamines (dopamine, norepinephrine and serotonin) this approach may have great potential. Current psychiatric guidelines for treatment of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and suicidal ideation do not include statements regarding the use of ketamine however research continues to be published. Ketamine is a rapid acting, non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist that is used as a general anesthetic with analgesic properties used in human and veterinary medicine. The NMDA receptor mediates glutamate excitatory neurotransmission in the brain, and it is hypothesized that a dysfunction in this regulation may play a role in the etiology of depressive symptoms. Ketamine is proposed to help balance the dysfunction, however, by blocking the NMDA receptor; side effects such as vivid dreams and a dissociative effect (where the patient experiences a separation of body and mind) occur frequently. While these side effects are undesirable for the therapeutics, it has created an illicit market for ketamine in certain populations where it is better known as "Special K". Ketaminecan be given through several routes including intravenous push or infusions, intramuscular, intranasal, and orally. Investigations have mainly utilized IV infusions due to the precise dosing and ability to adjust if known side effects occur. Patients who receive ketamine require close monitoring of blood pressure, heart rate, respiratory rate, transcutaneous O2 saturation as well as for emergence reactions (recovery reaction including agitation, hallucinations, dreams and depersonalization) when ketamine wears off. For this reason, current practice is for patients to receive the infusions in clinics with monitoring capabilities, which may be a significant shift in practice from current oral pharmacotherapy where patients can be monitored as outpatients. Given the lack of direction from major psychiatric associations, the utility of ketamine for certain mental health disorders is uncertain. The purpose of this report is to review the clinical effectiveness of intravenous ketamine for the treatment of depression, PTSD, and suicidal ideation, as well as the evidence-based guidelines for its use in these conditions. PDF  Biomarcadores humanos de los efectos de los antidepresivos rápidos Human biomarkers of rapid antidepressant effects. Zarate CA Jr, Mathews DC, Furey ML. Biol Psychiatry. 2013 Jun 15;73(12):1142-55. doi: 10.1016/j.biopsych.2012.11.031. Epub 2013 Jan 29. Abstract Mood disorders such as major depressive disorder and bipolar disorder--and their consequent effects on the individual and society--are among the most disabling and costly of all medical illnesses. Although a number of antidepressant treatments are available in clinical practice, many patients still undergo multiple and lengthy medication trials before experiencing relief of symptoms. Therefore a tremendous need exists to improve currenttreatment options and to facilitate more rapid, successful treatment in patients suffering from the deleterious neurobiological effects of ongoing depression. Toward that end, ongoing research is exploring the identification of biomarkers that might be involved in prevention, diagnosis, treatmentresponse, severity, or prognosis of depression. Biomarkers evaluating treatment response will be the focus of this review, given the importance of providing relief to patients in a more expedient and systematic manner. A novel approach to developing such biomarkers of response would incorporate interventions with a rapid onset of action--such as sleep deprivation or intravenous drugs (e.g., ketamine or scopolamine). This alternative translational model for new treatments in psychiatry would facilitate shorter studies, improve feasibility, and increase higher compound throughput testing for these devastating disorders. PDF Committee for European Education in Anaesthesiology (CEEA) Colegio de Anestesiólogos de León AC MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor. Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.   En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016. Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com  VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Bibliotecas. noticias

bibliotecas
Notificaciones diarias ⋅ 8 de mayo de 2016
NOTICIAS


Faro de Vigo
´Ricitos de oro´ desembarca en las bibliotecas cambadesas
Faro de Vigo
El miércoles 18 se cumple el centenario de las Irmandades da Fala, y la compañía A xanela do maxín estará a media tarde en la biblioteca Luís Rei ...




Cadena SER
¿Qué hacemos con las bibliotecas públicas?
Cadena SER
La Federación de Vecinos rechaza la reordenación de bibliotecas que estudia el gobierno local. Recordemos que la concejalía de acción cultural ...




Murcia.com
FEREMUR consigue la reapertura de las bibliotecas los fines de semana en Murcia
Murcia.com
La Federación Regional de Estudiantes Murcianos, FEREMUR, ha vuelto a lograr la apertura de 5bibliotecas los fines de semana en el municipio de ...



Presentan el segundo número de Rama Negra
Diario Democracia
El evento se desarrollará en la biblioteca Juan B. Justo, Pellegrini 76, y tiene como propuesta debatir entre los actores sociales involucrados y la ...




Europa Press
No al cierre de la biblioteca
elcorreoweb.es
El sector de alumnos de la Escuela Técnica Superior de Ingeniería (ETSI) de la Universidad de Sevilla ha iniciado un proceso de recogida de firmas, ...
Alumnos de Ingeniería de la US recogen firmas tras el cierre los sábados de la biblioteca de la ... -20minutos.es
Cobertura total de la noticia



SE ABRE EL PLAZO DE INSCRIPCIÓN PARA LOS TALLERES DE VERANO DE LABIBLIOTECA ...
Te Interesa
Este martes, 10 de mayo, se abre el plazo de inscripción para los talleres de verano de la Biblioteca Nacional de España (BNE), que tendrán lugar ...




Periódico AM
Restauran el acervo de Cervantes en Biblioteca Ferrer
Periódico AM
Una de las bibliotecas Cervantinas más importantes del país, Eulalio Ferrer, restaura y da mantenimiento a libros antiguos de Miguel de Cervantes.



EL DEBATE (Comunicado de prensa) (Registro) (blog)
Futuro de la Owen, sin riesgo
EL DEBATE (Comunicado de prensa) (Registro) (blog)
No hay riesgo sobre el futuro de la Biblioteca Estatal Gilberto Owen. El plazo que tiene el constructor para entregar esta obra es el último día de ...




Tribuna de Toledo
Los libros tienen que estar en todas partes
Tribuna de Toledo
El director de la Biblioteca regional, Juan Sánchez, reivindicó el papel de la cultura en una agenda política "economizada" y pidió una apuesta ...


WEB

Letras Galegas 2016
Biblioteca de Galicia - Xunta de Galicia
La Cidade da Cultura tiene previstas varias actividades para festejar este día. El Día de las Letras Gallegas tendrá como acto central en el Gaiás ...

Ketamina en ideas suicidas / Ketamine for suicidal ideation

Mayo 9, 2016. No. 2321

Ketamina como potencial tratamiento de ideación suicida. Revisión sistemática de la literatura Ketamine as a potential treatment for suicidal ideation: a systematic review of the literature. Reinstatler L1, Youssef NA. Drugs R D. 2015 Mar;15(1):37-43. doi: 10.1007/s40268-015-0081-0. Abstract OBJECTIVE: To review the published literature on the efficacy of ketamine for the treatment of suicidal ideation (SI). METHODS: The PubMed and Cochrane databases were searched up to January 2015 for clinical trials and case reports describing therapeuticketamine administration to patients presenting with SI/suicidality. Searches were also conducted for relevant background material regarding the pharmacological function of ketamine. RESULTS: Nine publications (six studies and three case reports) met the search criteria for assessing SI after administration of subanestheticketamine. There were no studies examining the effect on suicide attempts or death by suicide. Each study demonstrated a rapid and clinically significant reduction in SI, with results similar to previously described data on ketamine and treatment-resistant depression. A total of 137 patients with SI have been reported in the literature as receiving therapeutic ketamine. Seven studies delivered a dose of 0.5 mg/kg intravenously over 40 min, while one study administered a 0.2 mg/kg intravenous bolus and another study administered a liquid suspension. The earliest significant results were seen after 40 min, and the longest results were observed up to 10 days postinfusion. CONCLUSION: Consistent with clinical research on ketamine as a rapid and effective treatment for depression, ketamine has shown early preliminary evidence of a reduction in depressive symptoms, as well as reducing SI, with minimal short-term side effects. Additional studies are needed to further investigate its mechanism of action, long-term outcomes, and long-term adverse effects (including abuse) and benefits. In addition,ketamine could potentially be used as a prototype for further development of rapid-acting antisuicidal medication with a practical route of administration and the most favorable risk/benefit ratio. PDF   VIII Foro Internacional de Medicina del Dolor y Paliativa  Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Junio 9-11, Ciudad de México Dra. Argelia Lara Solares Tel. 5513 3782  www.dolorypaliativos.org

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Bupivacaína liposomal y TAP / TAP block and liposomal bupivacaine

Mayo 1, 2016. No. 2313

Comparación de infiltración con bupivacaína liposomal en TAP vs. Analgesia epidural continua vs. analgesia opioide intravenosa Comparison of Transversus Abdominis Plane Infiltration with Liposomal Bupivacaine versus Continuous Epidural Analgesia versus Intravenous Opioid Analgesia. Ayad S1, Babazade R2, Elsharkawy H3, Nadar V4, Lokhande C4, Makarova N5, Khanna R4, Sessler DI4, Turan A4. PLoS One. 2016 Apr 15;11(4):e0153675. doi: 10.1371/journal.pone.0153675. eCollection 2016. Abstract Epidural analgesia is considered the standard of care but cannot be provided to all patients Liposomal bupivacaine has been approved for field blocks such as transversus abdominis plane (TAP) blocks but has not been clinically compared against other modalities. In this retrospective propensity matched cohort study we thus tested the primary hypothesis that TAP infiltration are noninferior (not worse) to continuous epidural analgesia and superior (better) to intravenous opioid analgesia in patients recovering from major lower abdominal surgery. 318 patients were propensity matched on 18 potential factors among three groups (106 per group): 1) TAP infiltration with bupivacaine liposome; 2) continuous Epidural analgesia with plain bupivacaine; and; 3) intravenous patient-controlled analgesia (IV PCA). We claimed TAP noninferior (not worse) over Epidural if TAP was noninferior (not worse) on total morphine-equivalent opioid and time-weighted average pain score (10-point scale) within first 72 hours after surgery with noninferiority deltas of 1 (10-point scale) for pain and an increase less of 20% in the mean morphine equivalent opioid consumption. We claimed TAP or Epidural groups superior (better) over IV PCA if TAP or Epidural was superior on opioid consumption and at least noninferior on pain outcome. Multivariable linear regressions within the propensity-matched cohorts were used to model total morphine-equivalent opioid dose and time-weighted average pain score within first 72 hours after surgery; joint hypothesis framework was used for formal testing. TAP infiltration were noninferior to Epidural on both primary outcomes (p<0.001). TAP infiltration were noninferior to IV PCA on pain scores (p = 0.001) but we did not find superiority on opioid consumption (p = 0.37). We did not find noninferiority of Epidural over IV PCA on pain scores (P = 0.13) and nor did we find superiority on opioid consumption (P = 0.98). TAP infiltration with liposomal bupivacaine and continuous epidural analgesia were similar in terms of pain and opioid consumption, and not worse in pain compared with IV PCA. TAP infiltrations might be a reasonable alternative to epidural analgesia in abdominal surgical patients. A large randomized trial comparing these techniques is justified. PDF  Infiltración con bupivacaína liposomal en el plano transverso del abdomen para la analgesia post quirúrgica en la reparación de la hernia umbilical abdominal abierta: resultados de una cohorte de 13 pacientes. Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients. Feierman DE1, Kronenfeld M1, Gupta PM1, Younger N1, Logvinskiy E1. J Pain Res. 2014 Aug 16;7:477-82. doi: 10.2147/JPR.S65151. eCollection 2014. Abstract BACKGROUND: Achieving adequate control of postsurgical pain remains a challenge in patients undergoing abdominal surgery. Transversusabdominis plane (TAP) infiltration has been shown to provide postsurgical analgesia following lower abdominal surgery. We assessed the safety and efficacy of a prolonged-release liposomal formulation of the local anesthetic bupivacaine administered via infiltration into the TAP in a cohort of patients undergoing open abdominal umbilical hernia repair. METHODS: Patients included in the study were 18-75 years of age, had American Society of Anesthesiologists physical classification status 1-3, and underwent open abdominal umbilical hernia repair with ultrasound-guided TAP infiltration immediately after surgery using an equal-volume bilateral infusion of liposomal bupivacaine 266 mg (diluted to 30 mL in normal saline). Outcome measures included patient-reported pain intensity (11-point numeric rating scale), satisfaction with postsurgical analgesia (5-point Likert scale), incidence of opioid-related adverse events, and time to first use of supplemental rescue analgesia. RESULTS: Thirteen patients underwent surgery and received bilateral TAP infiltration with liposomal bupivacaine; TAP infiltration failed in the first patient. Mean numeric rating scale pain scores were 0.6 immediately before TAP infiltration and remained ≤2.3 through 120 hours after infiltration; mean scores at 120 hours and 10 days were 0.9 and 0.4, respectively. Ten patients (77%) required supplemental analgesia; median time to first use was 11 hours. At discharge and day 10, 54% and 62% of patients, respectively, were "extremely satisfied" with postsurgical analgesia (Likert score 5). There were no opioid-related or other adverse events. CONCLUSION: Although the current study was limited by both its lack of a control group and its small size, to our knowledge, it is the first published report on use of liposomal bupivacaine for TAP infiltration. In this cohort, liposomal bupivacaine was observed to be well tolerated with encouraging analgesic efficacy. KEYWORDS: analgesia; bupivacaine; hernia repair surgery; infiltration anesthesia; postoperative pain PDF Committee for European Education in Anaesthesiology (CEEA) Colegio de Anestesiólogos de León AC MÓDULO V: Sistema nervioso, fisiología, anestesia locoregional y dolor. Reconocimientos de: CEEA, CLASA, Consejo Nacional Mexicano de Anestesiología.   En la Ciudad de Léon, Guanajuato. México del 6 al 8 de Mayo, 2016. Informes en el tel (477) 716 06 16 y con el Dr. Enrique Hernández kikinhedz@gmail.com

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015