1 of 45

Slide Notes

DownloadGo Live

Anesthetic to Antidepressant

Published on Sep 10, 2019

No Description

View Outline

MORE DECKS TO EXPLORE

PRESENTATION OUTLINE

1.

Ketamine - Anesthetic to Antidepressant and Beyond

Photo by robnguyen01
2.

Untitled Slide

  • Associate Professor of Emergency Medicine, UBC
  • Staff Physician, Royal Inland Hospital, Kamloops
  • Cannabis Clinician & Researcher
3.

Disclosures

Board of Directors, KataCanada.org
Photo by Kristina Flour
4.

OUTLINE

  • Pharmacology
  • ED Use
  • Safety
  • Ketamine Associated Therapy
  • Regulatory Issues
Photo by Gareth1953 All Right Now
5.

PART 1

PHARMACOLOGY
6.

KETAMINE DOSING

7.

ROUTES OF ADMINISTRATION

8.

NMDA Antagonists

Ketamine, PCP,ibogaine, dextromethorphan
Photo by biologycorner
9.

PCP

Photo by sheila_blige
10.

Ibogaine

Photo by The Drug Users Bible
11.

DEXTROMETHORPHAN

Photo by Luke Hollins
12.

Opiate Induced Hyperalgesia

NMDA mediated
Poorly understood
Probably most active in chronic pain.
Can be reversed by ketamine
13.

Speculation

Can manipulation of NMDA receptors be part of opiate dependency treatment?

Photo by Oberazzi
14.

Part 2

Emergency Department Use
Photo by Robert Couse-Baker
15.

Hamilton

No ketamine for emergency physicians
Photo by Srini Sundarrajan
16.

Vancouver

Ketamine for abscess drainage in IDU
Photo by Aditya Chinchure
17.

St. Paul's

KETAMINE FOR TRAUMA & INTUBATION
Photo by Can Pac Swire
18.

ABU DHABI

PEDIATRIC KETAMINE
19.

Abu Dhabi

Ketamine for pediatric laceration repair
20.

Set and Setting

Photo by gl/gc?int=25
21.

Kamloops

KETAMINE FOR DEPRESSION
22.

MAPS - OAKLAND

23.

Untitled Slide

24.

Acute Suicide Treatment

Antidepressant dosage: 0.5-1 mg/kg iv
synapse growth
25.

EXTREME KETAMINE

  • Asthma
  • Status epilepticus
  • Sub dissociative dosing for pain
  • Behavioural control
26.

Pain-K Trial

Prehospital ketamine
9 km 4 hours
broken femur
27.

PART 3 - SAFETY

WHAT REALLY MATTERS?
Photo by C Drying
28.

Increased IOP

MYTH!
Photo by Ben Mortimer Photography
29.

Increased ICP

MYTH!
Photo by iem-student.org
30.

Psychosis

Photo by Christiaan Tonnis
31.

Complications

Vomiting
Photo by Steve E.
32.

BLOOD PRESSURE

Photo by jasleen_kaur
33.

Laryngospasm

  • children
  • break with 2 person BVM
  • Larsen maneuver
Laryngospasm in 0.3% of pediatric
Photo by iDanSimpson
34.

KETAMINE CYSTITIS

Photo by Lucas Davies
35.

What is the Maximum Dose?

J Emerg Med Sept 24, 2019
Photo by Jordane Mathieu
36.

PART 4 - KAT

Unexpected Meeting at Burning Man
37.

KETAMINE ASSISTED THERAPY

Photo by spike55151
38.

Ketamine OP Therapy

  • expensive
  • monitoring requirements
  • limited availability
  • followup
  • nasal vs sublingual vs intramuscular
Photo by theearlofgrey
39.

PART 5

Regulatory Issues
Photo by mag3737
40.

Untitled Slide

41.

CPSBC & Ketamine

  • ?Any non hospital ketamine
  • Spravato & the corporate agenda
  • Parenteral vs other forms
  • Very limited access
  • Similar issues in other provinces
Photo by Online Marketing
42.

Education Needed

  • Increase awareness of set and setting.
  • Standardize dosing and treatment
  • Help Colleges with safety data
Photo by Alfons Morales
43.

My Questions

  • Separate pharmacology from psychotherapy
  • Do some benefits require psychedelic dosing?
  • The importance of hyperalgesia
Photo by Veronique Debord
44.

Coffee to stay awake; for everything else there's KETAMINE


@travels2little

Photo by Jason Dent
45.

Esketamine

Ian Mitchell