5.8.24
Quick Review #135 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #ketamine
Ketamine is a dissociative anesthetic often used for sedation, pain management, and anesthesia. It has a wide range of applications in medical settings, including emergency medicine, procedural sedation, and intensive care.
Receptor:
• NMDA Receptors: Ketamine is an NMDA receptor antagonist, which means it inhibits the action of glutamate, the brain’s primary excitatory neurotransmitter. This blockade contributes to its anesthetic and analgesic effects.
• Opioid Receptors: It also interacts with mu and kappa opioid receptors, which contribute to its analgesic properties.
• Muscarinic Receptors: Ketamine inhibits muscarinic receptors, which contributes to some of its sedative and amnesic effects.
• Monoaminergic Receptors: Ketamine affects monoaminergic receptors, which might explain some of its antidepressant effects.
Effects of Ketamine
Sedation and Dissociation:
• Sedation: It induces a trance-like state characterized by sedation, analgesia, and amnesia.
• Dissociation: The dissociative state induced by ketamine is described as a feeling of being detached from the environment and self.
Analgesia:
• Ketamine provides strong pain relief, which is useful in emergency and postoperative settings.
Cardiovascular Effects:
• Heart Rate: Ketamine increases heart rate due to its sympathomimetic effects.
• Blood Pressure: It typically increases blood pressure through similar mechanisms.
• Cardiac Output: Cardiac output can increase as a result of the increased heart rate and blood pressure.
Respiratory Effects:
• Ketamine maintains respiratory drive, which is advantageous compared to other sedatives and anesthetics that suppress respiration.
Vital Sign Changes:
• Heart Rate: Increases.
• Blood Pressure: Increases.
• Respiratory Rate: Generally maintained, although there can be transient respiratory depression in higher doses.
• Oxygen Saturation: Generally maintained.
Safety Considerations:
• Laryngospasm: While ketamine generally preserves airway reflexes, laryngospasm can occur, especially in higher doses or when airway secretions increase.
• Emergence Reactions: Patients may experience vivid dreams, hallucinations, or delirium upon waking, although these can be minimized with benzodiazepines or lower doses.
• Intracranial Pressure: Ketamine can increase intracranial pressure, so caution is advised in patients with head injuries or raised intracranial pressure.
• Cardiovascular Effects: Due to its sympathetic stimulation, ketamine should be used cautiously in patients with cardiovascular disease or hypertension.
References:
1. Bailey, A. M., et al. (2018). Ketamine for Acute Pain Management and Sedation. Critical Care Nurse, 38(2), 49-59 .
2. Schmid, R. L., et al. (2005). Ketamine for Perioperative Pain Management. Anesthesiology, 102(1), 211-220.
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