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Published on Sep 10, 2019

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MORE DECKS TO EXPLORE

PRESENTATION OUTLINE

1.

Ketamine - Anesthetic to Antidepressant and Beyond

Photo by robnguyen01
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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
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7.

Bioavailability

  • IM - 93%
  • IN - 45%
  • SL - 25 %
  • PO - 17% + norketamine
8.

Esketamine

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NMDA Antagonists

Ketamine, PCP,ibogaine, dextromethorphan
Photo by biologycorner
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PCP

Photo by sheila_blige
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Ibogaine

Photo by The Drug Users Bible
12.

DEXTROMETHORPHAN

Photo by Luke Hollins
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Opiate Induced Hyperalgesia

NMDA mediated
Poorly understood
Probably most active in chronic pain.
Can be reversed by ketamine
14.

Speculation

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

Photo by Oberazzi
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Part 2

Emergency Department Use
Photo by Robert Couse-Baker
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Hamilton

No ketamine for emergency physicians
Photo by Srini Sundarrajan
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Vancouver

Ketamine for abscess drainage in IDU
Photo by Aditya Chinchure
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St. Paul's

KETAMINE FOR TRAUMA & INTUBATION
Photo by Can Pac Swire
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ABU DHABI

PEDIATRIC KETAMINE
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Abu Dhabi

Ketamine for pediatric laceration repair
21.

Set and Setting

Brief report: the effect of suggestion on unpleasant dreams induced by ketamine administration

https://pubmed.ncbi.nlm.nih.gov/21346162/
Photo by gl/gc?int=25
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Kamloops

KETAMINE FOR DEPRESSION
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MAPS - OAKLAND

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Untitled Slide

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Acute Suicide Treatment

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

  • Asthma
  • Status epilepticus
  • Subdissociative for pain
  • Behavioural control
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Pain-K Trial

Prehospital ketamine
9 km 4 hours
broken femur
28.

PART 3 - SAFETY

WHAT REALLY MATTERS?
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Increased IOP

MYTH!
Photo by Ben Mortimer Photography
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Increased ICP

MYTH!
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Psychosis

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32.

BLOOD PRESSURE

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Complications

Vomiting
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34.

Laryngospasm

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

Photo by Lucas Davies
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What is the Maximum Dose?

J Emerg Med Sept 24, 2019
Photo by Jordane Mathieu
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PART 4 - KAT

Unexpected Meeting at Burning Man
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KETAMINE ASSISTED THERAPY

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39.

Ketamine OP Therapy

  • expensive
  • monitoring requirements
  • limited availability
  • followup
  • nasal vs sublingual vs intramuscular
Photo by theearlofgrey
40.

PART 5

Regulatory Issues
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42.

CPSBC & Ketamine

  • ?Any non hospital ketamine
  • Spravato & the corporate agenda
  • New Interim Guidance
  • IM, IN, SL in community
Photo by Online Marketing
43.

Education Needed

  • Increase awareness of set and setting.
  • Standardize dosing and treatment
  • Set reasonable guidelines balanceing safety and cost
Photo by Alfons Morales
44.

My Questions

  • Separate pharmacology from psychotherapy
  • Do some benefits require psychedelic dosing?
  • The importance of hyperalgesia
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45.

@travels2little
www.katacanada.org

Photo by Scott McLeod

Ian Mitchell