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Anesthetic to Antidepressant

Published on Sep 10, 2019

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PRESENTATION OUTLINE

Ketamine - Anesthetic to Antidepressant and Beyond

Photo by robnguyen01

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

Disclosures

Board of Directors, KataCanada.org

OUTLINE

  • Pharmacology
  • ED Use
  • Safety
  • Ketamine Associated Therapy
  • Regulatory Issues

PART 1

PHARMACOLOGY

KETAMINE DOSING

ROUTES OF ADMINISTRATION

NMDA Antagonists

Ketamine, PCP,ibogaine, dextromethorphan
Photo by biologycorner

PCP

Photo by sheila_blige

Ibogaine

DEXTROMETHORPHAN

Photo by Luke Hollins

Opiate Induced Hyperalgesia

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

Speculation

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

Photo by Oberazzi

Part 2

Emergency Department Use

Hamilton

No ketamine for emergency physicians

Vancouver

Ketamine for abscess drainage in IDU

St. Paul's

KETAMINE FOR TRAUMA & INTUBATION
Photo by Can Pac Swire

ABU DHABI

PEDIATRIC KETAMINE

Abu Dhabi

Ketamine for pediatric laceration repair

Set and Setting

Photo by gl/gc?int=25

Kamloops

KETAMINE FOR DEPRESSION

MAPS - OAKLAND

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Acute Suicide Treatment

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

EXTREME KETAMINE

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

Pain-K Trial

Prehospital ketamine
9 km 4 hours
broken femur

PART 3 - SAFETY

WHAT REALLY MATTERS?
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Increased IOP

MYTH!

Increased ICP

MYTH!

Psychosis

Complications

Vomiting
Photo by Steve E.

BLOOD PRESSURE

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Laryngospasm

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

KETAMINE CYSTITIS

Photo by Lucas Davies

What is the Maximum Dose?

J Emerg Med Sept 24, 2019

PART 4 - KAT

Unexpected Meeting at Burning Man

KETAMINE ASSISTED THERAPY

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Ketamine OP Therapy

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

PART 5

Regulatory Issues
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CPSBC & Ketamine

  • ?Any non hospital ketamine
  • Spravato & the corporate agenda
  • Parenteral vs other forms
  • Very limited access
  • Similar issues in other provinces

Education Needed

  • Increase awareness of set and setting.
  • Standardize dosing and treatment
  • Help Colleges with safety data

My Questions

  • Separate pharmacology from psychotherapy
  • Do some benefits require psychedelic dosing?
  • The importance of hyperalgesia

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


@travels2little

Photo by Jason Dent

Esketamine