Your SlideShare is downloading. ×
Second life of Ketamine
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Second life of Ketamine

860
views

Published on

presented on scientific day department of anesthesiology

presented on scientific day department of anesthesiology


0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
860
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
0
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. S(+)-ketamine Treatment of Acute and Chronic Pain Marnix Sigtermans, MD Department of Anesthesiology
  • 2. Chronic pain
    • 19% of 46,394 respondents suffered pain for > 6 months
    • 61 % were less able or unable to work
    • 19% had lost their job becaus of pain
    • 40% inadequate pain managment
  • 3. Introduction: NMDA receptor antagonists
    • Fencyclidine (PCP) was developed in 1926
    • NMDA-receptor antagonist
    • Patented 1950
    • Anesthetic drug
    • Side effects: hallucinogenic and neurotoxic
    • Mid 1960’s ketamine, a new NMDA receptor antagonist
    • Anesthetic drug
    • Analgesic drug in anesthetic doses
  • 4. Study objectives
    • Characterization of efficacy and safety
    • of ketamine in:
    • Healthy volunteers
    • CRPS patients
      • Efficacy: analgesia (heat pain model)
      • Safety: haemodynamic, psychomimetic effects
  • 5. Healthy volunteers
  • 6.  
  • 7.
      • Does treatment with ketamine result in pain reduction in chronic pain patients?
    • Complex Regional Pain Syndrome type 1
    • (posttraumatic dystrophy)
      • Affects one or more extremities
      • Standard pain management often inadequate
      • Relative young patients
      • Low quality of life and high costs for society
  • 8. CRPS-1: International Association for the Study of Pain
    • Complex Regional Pain Syndrome type 1 (sympathetic reflex dystrophy or posttraumatic dystrophy)
    • Following a trauma
    • Effects the extremities
    • Pain and / or dystonic major complaints
    • CRITERIA
      • Presence of a noxious event, or immobilization
      • Continuing pain, allodynia or hyperalgesia,
      • (pain disproportionate)
      • Edema, changes in skin blood flow
      • and/or abnormal sudomotor activity
      • No other explanation
  • 9. CRPS type 1: example
  • 10. Example continued
  • 11. Flowchart
  • 12. Infusion period
  • 13. Time course of analgetic effect P <0.001
  • 14. Side effects during treatment
    • No changes in:
      • Blood pressure
      • Liver function test
    P < 0.001 P = 0.004 P < 0.001 P = 0.78
  • 15. CRPS acute and chronic pain Infusion phase Elimination phase
  • 16. Results: n=12
  • 17. CRPS Experimental pain
  • 18. CRPS Experimental pain CRPS pain
  • 19. Conclusion
    • Difference between onset and offset of analgetic action of ketamine
      • Pharmacokinetic driven
    • This suggests that apart from an analgesic effect ketamine displays a modulatory effect on the chronic pain process
  • 20. Conclusion