Read by QxMD icon Read

Ketamine for neurologic pain

Lauren K Dunn, Bhiken I Naik, Edward C Nemergut, Marcel E Durieux
Craniotomy pain may be severe and is often undertreated. Pain management following craniotomy is a balancing act of achieving adequate analgesia but avoiding sedation, respiratory depression, hypercapnia, nausea and vomiting, and hypertension. Opioids are a first-line analgesic therapy; however, concern that opioid-related adverse effects (sedation, respiratory depression) may interfere with neurologic assessment and increase intracranial pressure has limited use of these drugs for intracranial surgery. Non-opioid analgesics avoid these effects and may be useful as part of a multimodal regimen for post-craniotomy pain...
October 2016: Current Neurology and Neuroscience Reports
Mauro Oddo, Ilaria Alice Crippa, Sangeeta Mehta, David Menon, Jean-Francois Payen, Fabio Silvio Taccone, Giuseppe Citerio
Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradigm of minimal sedation can be translated to the neuro-ICU (NICU) is unclear...
2016: Critical Care: the Official Journal of the Critical Care Forum
Ahmed Sobhy Basuni
BACKGROUND AND AIMS: Spinal anesthesia for cesarean section (CS) is associated with an incidence of hypotension of 60-94%. This study hypothesizes that intrathecal combination of low-dose ketamine, midazolam, and low-dose bupivacaine improves hemodynamics and postoperative analgesia compared with fentanyl and low-dose bupivacaine during CS. MATERIAL AND METHODS: Fifty parturients undergoing elective CS were randomized equally to receive ketamine (10 mg), midazolam (2 mg) and 0...
January 2016: Journal of Anaesthesiology, Clinical Pharmacology
Ryan Grant, Shaun E Gruenbaum, Jason Gerrard
PURPOSE OF REVIEW: Deep brain stimulation (DBS) is a well tolerated and efficacious surgical treatment for movement disorders, chronic pain, psychiatric disorder, and a growing number of neurological disorders. Given that the brain targets are deep and small, accurate electrode placement is commonly accomplished by utilizing frame-based systems. DBS electrode placement is confirmed by microlectrode recordings and macrostimulation to optimize and verify target placement. With a reliance on electrophysiology, proper anaesthetic management is paramount to balance patient comfort without interfering with neurophysiology...
October 2015: Current Opinion in Anaesthesiology
Brian M Radvansky, Shawn Puri, Anthony N Sifonios, Jean D Eloy, Vanny Le
One of the most fascinating drugs in the anesthesiologist's armament is ketamine, an N-methyl-D-aspartate receptor antagonist with a myriad of uses. The drug is a dissociative anesthetic and has been used more often as an analgesic in numerous hospital units, outpatient pain clinics, and in the prehospital realm. It has been used to treat postoperative pain, chronic pain, complex regional pain syndrome, phantom limb pain, and other neuropathic conditions requiring analgesia. Research has also demonstrated its efficacy as an adjunct in psychotherapy, as a treatment for both depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and neurologic conditions...
April 24, 2015: American Journal of Therapeutics
Pradip P Kamat, Courtney E McCracken, Scott E Gillespie, James D Fortenberry, Jana A Stockwell, Joseph P Cravero, Kiran B Hebbar
OBJECTIVE: Increasing demand for pediatric procedural sedation has resulted in a marked increase in provision of pediatric procedural sedation by pediatric critical care physicians both inside and outside of the ICU. Reported experience of pediatric critical care physicians-administered pediatric procedural sedation is limited. We used the Pediatric Sedation Research Consortium database to evaluate a multicenter experience with propofol by pediatric critical care physicians in all settings...
January 2015: Pediatric Critical Care Medicine
Michael S Avidan, Bradley A Fritz, Hannah R Maybrier, Maxwell R Muench, Krisztina E Escallier, Yulong Chen, Arbi Ben Abdallah, Robert A Veselis, Judith A Hudetz, Paul S Pagel, Gyujeong Noh, Kane Pryor, Heiko Kaiser, Virendra Kumar Arya, Ryan Pong, Eric Jacobsohn, Hilary P Grocott, Stephen Choi, Robert J Downey, Sharon K Inouye, George A Mashour
INTRODUCTION: Postoperative delirium is one of the most common complications of major surgery, affecting 10-70% of surgical patients 60 years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50 years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes...
2014: BMJ Open
Simon C Baker, Jens Stahlschmidt, Jon Oxley, Jennifer Hinley, Ian Eardley, Fiona Marsh, David Gillatt, Simon Fulford, Jennifer Southgate
BACKGROUND: There is an emerging association between ketamine abuse and the development of urological symptoms including dysuria, frequency and urgency, which have a neurological component. In addition, extreme cases are associated with severe unresolving bladder pain in conjunction with a thickened, contracted bladder and an ulcerated/absent urothelium. Here we report on unusual neuropathological features seen by immunohistology in ketamine cystitis. RESULTS: In all cases, the lamina propria was replete with fine neurofilament protein (NFP+) nerve fibres and in most patients (20/21), there was prominent peripheral nerve fascicle hyperplasia that showed particular resemblance to Morton's neuroma...
2013: Acta Neuropathologica Communications
Maarten Swartjes, Marieke Niesters, Lara Heij, Ann Dunne, Leon Aarts, Carla Cerami Hand, Hyung-Suk Kim, Michael Brines, Anthony Cerami, Albert Dahan
Neuropathic pain (NP) is a debilitating condition associated with traumatic, metabolic, autoimmune and neurological etiologies. Although the triggers for NP are diverse, there are common underlying pathways, including activation of immune cells in the spinal cord and up-regulation of the N-methyl-D-aspartate receptor (NMDAR). Ketamine, a well-known NDMAR antagonist, reduces neuropathic pain in a sustained manner. Recent study has shown that the novel 11-amino acid peptide erythropoietin derivative ARA290 produces a similar, long-lasting relief of NP...
2013: PloS One
Chan Yiu-Cheung
Ketamine has been the commonest abusive substance used by Hong Kong teenager since 2005. It is also the fourth commonest poison encountered in Hong Kong Poison Information Centre (HKPIC) poisoning data in 2010. From June 2008 to July 2011, HKPIC managed 188 and 96 cases of acute and chronic ketamine poisoning, respectively, which reflect its acute and chronic toxicity pattern. Demographically, there is a male predominance, and the majority is between the ages of 10-39. For the acute cases, 48 % presented with neurological features such as confusion, drowsiness, or transient loss of consciousness which usually subside with supportive care in a few hours...
September 2012: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
D R Pachman, D L Barton, J C Watson, C L Loprinzi
Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting side effect of many chemotherapeutic agents. Although many therapies have been investigated for the prevention and/or treatment of CIPN, there is no well-accepted proven therapy. In addition, there is no universally accepted, well-validated measure for the assessment of CIPN. The agents for which there are the strongest preliminary data regarding their potential efficacy in preventing CIPN are intravenous calcium and magnesium (Ca/Mg) infusions and glutathione...
September 2011: Clinical Pharmacology and Therapeutics
Celia J A Morgan, H Valerie Curran
AIMS: Ketamine remains an important medicine in both specialist anaesthesia and aspects of pain management. At the same time, its use as a recreational drug has spread in many parts of the world during the past few years. There are now increasing concerns about the harmful physical and psychological consequences of repeated misuse of this drug. The aim of this review was to survey and integrate the research literature on physical, psychological and social harms of both acute and chronic ketamine use...
January 2012: Addiction
Steven P Cohen, Wesley Liao, Anita Gupta, Anthony Plunkett
Ketamine is an N-methyl-D-aspartate receptor antagonist that has been in clinical use in the USA for over 30 years. Its ability to provide profound analgesia and amnesia while maintaining spontaneous respiration makes it an ideal medication for procedure-related pain and trauma. In the chronic pain arena, its use continues to evolve. There is strong evidence to support its short-term use for neuropathic and nociceptive pain, and conflicting evidence for preemptive analgesia. Its potential ability to prevent 'windup' and, possibly, 'reboot' aberrant neurologic pathways in neuropathic and central pain states has generated intense interest...
2011: Advances in Psychosomatic Medicine
Chiyo Sato, Tadashi Okabe, Kazuhiro Nakanishi, Atsuhiro Sakamoto
Titration of oral or intravenous medication is the preferred method of pain management for most patients with cancer pain. However, some patients experience insufficient pain relief or considerable adverse effects from systemic opioids. For these reasons, the control of severe cancer pain continues to present a variety of challenges to clinicians. We report our experience of successfully managing cancer pain in a patient by means of long-term intrathecal administration of morphine, bupivacaine, and racemic ketamine via a patient-controlled delivery system...
December 2010: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
Raphaël Gaillard, Henry Loo, Jean-Pierre Olie
The psychiatrist is confronted by a variety of emotional states, ranging from sadness to exaltation. The term "psychache "has been used to describe depression with melancholic features. But can such mental pain be defined without reference to visible lesions or precise physical symptoms? We report pathophysiological evidence supporting this concept and show that it has implications for both treatment and prognosis. Cognitive studies have shown that the neurological substrate of physical pain is also activated by mental pain...
March 2010: Bulletin de L'Académie Nationale de Médecine
Kate Jackson, Michael Ashby, Deb Howell, Jennifer Petersen, David Brumley, Phillip Good, Maria Pisasale, Simon Wein, Roger Woodruff
This multi-centre study of adjuvant "burst" ketamine in palliative care in-patients documents its effectiveness, duration of pain relief, and adverse effects (AE) profile. Patients received a three-to-five day continuous subcutaneous infusion (CSCI) of ketamine escalated from 100 to 300 to 500 mg/24 hours if required. When the effective or maximum tolerated dose was attained, the infusion was continued for three days and each patient assessed as a responder or non-responder using strict criteria. The response rate was 22/44 (50 percent), with 4 (9 percent) becoming pain-free...
2010: Journal of Palliative Care
Takafumi Tanei, Yasukazu Kajita, Toshihiko Wakabayashi
A 33-year-old man presented with ongoing severe right facial pain and sensory disturbances caused by multiple sclerosis (MS). Neuroimaging demonstrated demyelinating lesions in the right dorsal pons and medulla oblongata. The pain was refractory to carbamazepine at 800 mg/day, gabapentin at 1800 mg/day, morphine at 30 mg/day, amitriptyline at 60 mg/day, and diazepam at 4 mg/day, along with twice-monthly ketamine (60 mg) drip infusions. The patient underwent motor cortex stimulation (MCS), resulting in >60% pain relief, reduction in the required doses of pain medications, and discontinuation of ketamine administration...
2010: Neurologia Medico-chirurgica
Albert Dahan, Erik Olofsen, Marnix Sigtermans, Ingeborg Noppers, Marieke Niesters, Leon Aarts, Martin Bauer, Elise Sarton
AIMS: Pharmacological treatment of chronic (neuropathic) pain is often disappointing. In order to enhance our insight in the complex interaction between analgesic drug and chronic pain relief, we performed a pharmacokinetic-pharmacodynamic (PK-PD) modeling study on the effect of S(+)-ketamine on pain scores in Complex Regional Pain Syndrome type 1 (CRPS-1) patients. METHODS: Sixty CRPS-1 patients were randomly allocated to received a 100-h infusion of S(+)-ketamine or placebo...
March 2011: European Journal of Pain: EJP
Jan Persson
PURPOSE OF REVIEW: Ketamine has been repeatedly reviewed in this journal but novel developments have occurred in the last few years prompting an update. Interesting recent publications will be highlighted against a background of established knowledge. RECENT FINDINGS: In the field of anesthesia, particularly in pediatrics, some contributions have been made concerning intramuscular versus intravenous induction. The need for anticholinergic adjuvants has also been clarified...
August 2010: Current Opinion in Anaesthesiology
Marcin Rawicz
The purpose of the study was to present recommendations, relevant to the management of neonates and infants aged 0-1 years, treated in intensive care settings. They include general principles and recommendations for pain and sedation assessment, sedation and pain management and advice on the use of pharmacological strategies. The bolus (on demand) administration of sedative agents should be avoided because of increased risk of cardiovascular depression and/or neurological complications. Midazolam administration time should be limited to 72 hours because of tachyphylaxis, and the possibility of development of a withdrawal syndrome and neurological complications (grade A, LOE 1b)...
October 2008: Medycyna Wieku Rozwojowego
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"