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By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Kelly Jonkman, Tine van de Donk, Albert Dahan
PURPOSE OF REVIEW: In this review, we assess the benefit of ketamine in the treatment of terminal cancer pain that is refractory to opioid treatment and/or complicated by neuropathy. RECENT FINDINGS: While randomized controlled trials consistently show lack of clinical efficacy of ketamine in treating cancer pain, a large number of open-label studies and case series show benefit. SUMMARY: Ketamine is an N-methyl-D-aspartate receptor antagonist that at low-dose has effective analgesic properties...
June 2017: Current Opinion in Supportive and Palliative Care
Lael Reinstatler, Nagy A Youssef
OBJECTIVE: To review the published literature on the efficacy of ketamine for the treatment of suicidal ideation (SI). METHODS: The PubMed and Cochrane databases were searched up to January 2015 for clinical trials and case reports describing therapeutic ketamine administration to patients presenting with SI/suicidality. Searches were also conducted for relevant background material regarding the pharmacological function of ketamine. RESULTS: Nine publications (six studies and three case reports) met the search criteria for assessing SI after administration of subanesthetic ketamine...
March 2015: Drugs in R&D
André Schmidt, Rosilla Bachmann, Michael Kometer, Philipp A Csomor, Klaas E Stephan, Erich Seifritz, Franz X Vollenweider
Psychotomimetics like the N-methyl-D-aspartate receptor (NMDAR) antagonist ketamine and the 5-hydroxytryptamine2A receptor (5-HT(2A)R) agonist psilocybin induce psychotic symptoms in healthy volunteers that resemble those of schizophrenia. Recent theories of psychosis posit that aberrant encoding of prediction errors (PE) may underlie the expression of psychotic symptoms. This study used a roving mismatch negativity (MMN) paradigm to investigate whether the encoding of PE is affected by pharmacological manipulation of NMDAR or 5-HT(2A)R, and whether the encoding of PE under placebo can be used to predict drug-induced symptoms...
March 2012: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
R Edward Roberts, H Valerie Curran, Karl J Friston, Celia J A Morgan
Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that has been found to induce schizophrenia-type symptoms in humans and is a potent and fast-acting antidepressant. It is also a relatively widespread drug of abuse, particularly in China and the UK. Acute administration has been well characterized, but the effect of extended periods of ketamine use-on brain structure in humans-remains poorly understood. We measured indices of white matter microstructural integrity and connectivity in the brain of 16 ketamine users and 16 poly-drug-using controls, and we used probabilistic tractography to quantify changes in corticosubcortical connectivity associated with ketamine use...
January 2014: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
Jeffrey Burgdorf, Xiao-lei Zhang, Katherine L Nicholson, Robert L Balster, J David Leander, Patric K Stanton, Amanda L Gross, Roger A Kroes, Joseph R Moskal
Recent human clinical studies with the NMDA receptor (NMDAR) antagonist ketamine have revealed profound and long-lasting antidepressant effects with rapid onset in several clinical trials, but antidepressant effects were preceded by dissociative side effects. Here we show that GLYX-13, a novel NMDAR glycine-site functional partial agonist, produces an antidepressant-like effect in the Porsolt, novelty induced hypophagia, and learned helplessness tests in rats without exhibiting substance abuse-related, gating, and sedative side effects of ketamine in the drug discrimination, conditioned place preference, pre-pulse inhibition and open-field tests...
April 2013: Neuropsychopharmacology: Official Publication of the American College of Neuropsychopharmacology
James W Murrough, Dan V Iosifescu, Lee C Chang, Rayan K Al Jurdi, Charles E Green, Andrew M Perez, Syed Iqbal, Sarah Pillemer, Alexandra Foulkes, Asim Shah, Dennis S Charney, Sanjay J Mathew
OBJECTIVE: Ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, has shown rapid antidepressant effects, but small study groups and inadequate control conditions in prior studies have precluded a definitive conclusion. The authors evaluated the rapid antidepressant efficacy of ketamine in a large group of patients with treatment-resistant major depression. METHOD: This was a two-site, parallel-arm, randomized controlled trial of a single infusion of ketamine compared to an active placebo control condition, the anesthetic midazolam...
October 2013: American Journal of Psychiatry
Janet Hardy, Stephen Quinn, Belinda Fazekas, John Plummer, Simon Eckermann, Meera Agar, Odette Spruyt, Debra Rowett, David C Currow
PURPOSE: The anesthetic ketamine is widely used for pain related to cancer, but the evidence to support its use in this setting is weak. This study aimed to determine whether ketamine is more effective than placebo when used in conjunction with opioids and standard adjuvant therapy in the management of chronic uncontrolled cancer pain. Ketamine would be considered of net benefit if it provided clinically relevant improvement in pain with limited breakthrough analgesia and acceptable toxicity...
October 10, 2012: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Steven M Green, Mark G Roback, Baruch Krauss, Lance Brown, Ray G McGlone, Dewesh Agrawal, Michele McKee, Markus Weiss, Raymond D Pitetti, Mark A Hostetler, Joe E Wathen, Greg Treston, Barbara M Garcia Pena, Andreas C Gerber, Joseph D Losek
STUDY OBJECTIVE: Although ketamine is one of the most commonly used sedatives to facilitate painful procedures for children in the emergency department (ED), existing studies have not been large enough to identify clinical factors that are predictive of uncommon airway and respiratory adverse events. METHODS: We pooled individual-patient data from 32 ED studies and performed multiple logistic regressions to determine which clinical variables would predict airway and respiratory adverse events...
August 2009: Annals of Emergency Medicine
Edward B Perry, Joyce A Cramer, Hyun-Sang Cho, Ismene L Petrakis, Laurence P Karper, Angelina Genovese, Elizabeth O'Donnell, John H Krystal, D Cyril D'Souza
RATIONALE: A growing number of investigators are studying ketamine effects in healthy human subjects, but concerns remain about its safety as a research tool. Therefore, it is timely to revisit the safety of subanesthetic doses of ketamine in experimental psychopharmacology studies. OBJECTIVE: To report on the safety of laboratory studies with subanesthetic doses of ketamine in healthy humans using an existing dataset. MATERIALS AND METHODS: Medically healthy subjects with no personal or familial Axis I psychotic spectrum disorders were administered subanesthetic doses of ketamine by intravenous infusion in a series of clinical investigations from 1989 to 2005...
June 2007: Psychopharmacology
Finn L S Coulter, Jacqueline A Hannam, Brian J Anderson
BACKGROUND: Propofol mixed with racemic ketamine (or 'ketofol') is popular for short procedural sedation and analgesia. Use is creeping into anesthesia, yet neither the optimal combination nor infusion rate is known. The EC(50) of propofol's antiemetic effect is reported to be 0.343 mg·l(-1), while ketamine analgesia is thought to persist with concentrations above 0.2 mg·l(-1). We aimed to determine a ketofol dosing regimen for anesthesia 30-min and 1.5-h duration in a healthy child that did not unduly compromise recovery...
August 2014: Paediatric Anaesthesia
Christophe Aveline, Alain Le Roux, Hubert Le Hetet, Jean F Gautier, Pierre Vautier, Fabrice Cognet, Francis Bonnet
OBJECTIVES: Ketamine and nefopam has been documented to decrease pain intensity and improve rehabilitation after total knee arthroplasty (TKA). We conducted a follow-up study of a previously randomized clinical trial to determine the prevalence and risk factors of chronic pain 1 year after TKA and to assess the role of perioperative administration of ketamine and nefopam. MATERIALS AND METHODS: The original randomized, double-blind trial evaluated postoperative pain in 75 patients scheduled for TKA who received either a 48-hour infusion of ketamine or nefopam compared with placebo...
September 2014: Clinical Journal of Pain
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