Ketamine: Uses, Effects & Mechanism of Action w. Dr. Kelly Elmore, Mary Baldwin University

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Ketamine: A Unique Anesthetic with Diverse Applications

Dive deep into the world of ketamine, exploring its history, pharmacology, mechanism of action, clinical uses, and side effects. Dr. Kelly Elmore, Assistant Program Director at Mary Baldwin University's Nurse Anesthesiology Program, guides listeners through this fascinating drug, highlighting its potential for anesthesia, pain management, and even mental health treatment.

Targeting NMDA Receptors for Dissociative Anesthesia

Ketamine is classified as a dissociative anesthetic, distinct from depressant anesthetics like propofol. It primarily works by blocking NMDA receptors in the central nervous system, thereby reducing excitatory signals and producing profound analgesia and amnesia. This mechanism also contributes to the characteristic dissociative state, where patients may appear detached from their environment and experience hallucinations.

Beyond Anesthesia: Exploring Ketamine's Diverse Uses

Beyond its role in anesthesia, ketamine offers a range of benefits in various clinical settings:

• Pain Management: Ketamine's analgesic properties make it valuable for treating acute and chronic pain conditions, including neuropathic pain, complex regional pain syndrome, and post-surgical pain.
• Mental Health: Emerging research suggests ketamine's potential in treating treatment-resistant depression, PTSD, and suicidal ideation. Low-dose ketamine infusions combined with psychotherapy have shown promise in these areas in the form of ketamine-assisted therapy.
• Emergency Medicine: Due to its bronchodilatory effects and ability to maintain airway patency, ketamine is a valuable tool in emergency departments for managing patients with respiratory distress.

Important Considerations for Ketamine Use

While ketamine offers numerous advantages, it's crucial to be aware of its potential drawbacks:

• Side Effects: Nausea, vomiting, and hallucinations are common side effects, particularly at higher doses.
• Abuse Potential: Ketamine's popularity as a street drug necessitates caution, especially in outpatient mental health settings.
• Cardiac Effects: In critically ill patients with depleted catecholamines, ketamine can worsen cardiovascular depression.
• Mental Health Risks: Ketamine may exacerbate symptoms in some mental health disorders.

S-Ketamine: A Promising Option for Treatment-Resistant Depression

The FDA-approved S-ketamine nasal spray offers a new avenue for treating treatment-resistant depression. This medication is typically used alongside other oral antidepressants.

Conclusion: A Multifaceted Drug with Ongoing Research

Ketamine's unique properties make it a valuable tool for CRNAs across various healthcare settings. Ongoing research continues to explore its potential benefits and refine its use for optimal patient care.

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