Ex1 Ketamine Slides

Question 1

Ketamine produces ______ anesthesia in the _______

Answer 1

Dissociative —— thalamocortical and limbic dissociation

Question 2

Resembles a ______ state

Answer 2

Cataleptic

Question 3

Description of patient under Ketamine anesthesia

Answer 3

Eyes open, slow nystagmic gaze
Non-communicative
Varying degrees of hyper tones, voluntary skeletal muscle movement

Question 4

Ketamine is a ______ derivative

Answer 4

Phencyclidine

Question 5

Potent ________ effects even at subanesthetic doses

Answer 5

Analgesic

Question 6

What is advocated for during emergence?

Answer 6

Concurrent Benzo use

Question 7

What may happen during emergence?

Answer 7

Delirium and hallucinations

Question 8

MOA ketamine

Answer 8

Mainly: NMDA receptor antagonist
Others: 
Opiate (Mu, Delta, Kappa)
Muscarinic (responsible for delirium, bronchodilation)
Voltage gated Ca channels
Monoaminergic receptors

Question 9

Induction dose IV

Answer 9

1-2mg/kg IV bolus

Question 10

Induction dose IM

Answer 10

4-8 mg/kg

Question 11

Loss of consciousness after induction

Answer 11

IV <60s

IM 2-4min

Question 12

Return to consciousness

Answer 12

~ 15min; full orientation 1 hr

Question 13

_______ is maintained during ketamine administration

Answer 13

Swallowing - but does not mean protective reflexes are maintained

Question 14

Effects on CNS

Answer 14

Increased CMRO2, CBF, ICP

Cerebrovascular response to CO2 is preserved

Question 15

How to decrease CBF?

Answer 15

Hyperventilation

Possible because cerebrovascular response to CO2 is preserved

Question 16

CV Effects

Answer 16

Effects resemble SNS stimulation

Increased BP, HR, CO, MRO2

Question 17

If ketamine is administered and CO/BP are decreased, what does this suggest?

Answer 17

Depletion of endogenous catecholamines

Unmasking of direct myocardial depressant effects

Question 18

Effects on Ventilation

Answer 18

No significant depression of ventilation
CO2 response maintained
Bronchial smooth muscle relaxant
Increased salivation

Question 19

Chronic ketamine use results in

Answer 19

Induces the enzymes that metabolize it
Rapid escalation in tolerance
P450 enzymes