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Pickering G. [Ketamine in chronic pain]. Biol Aujourdhui 2023; 217:145-149. [PMID: 38018941 DOI: 10.1051/jbio/2023019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Indexed: 11/30/2023]
Abstract
Ketamine is now frequently used in the management of chronic pain refractory to conventional treatments. However, its efficacy and adverse effects appear variable in the literature in line with heterogeneous methodologies and modes of administration, leading to controversy regarding the actual interest of ketamine for chronic pain treatment. A need for clinical trials on larger cohorts of well selected patients but also real-life studies to more accurately quantify its efficacy, refine its prescription dosages and better understand its long-term adverse effects is highlighted in the literature. Progress in this direction has been achieved in recent years with improved recommendations for use, taking into account different trajectories of analgesia with ketamine, depending on the etiology of the pain, and the psycho-affective profile of patients. A holistic approach is clearly needed with consideration of pain and depression comorbidities to optimize pain management.
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Affiliation(s)
- Gisèle Pickering
- Plateforme d'Investigation Clinique / Centre d'Investigation Clinique Inserm 1405 - CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France - Laboratoire Neuro-Dol Inserm 1107, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
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The effect of topical ketamine administration on the corneal epithelium repair. Sci Rep 2022; 12:21465. [PMID: 36509846 PMCID: PMC9744879 DOI: 10.1038/s41598-022-24639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
The cornea is regarded as a sensitive organ to pain. Ketamine can effectively reduce postoperative neuropathic pain. We hypothesized that topical ketamine could mitigate postoperative corneal neuropathic pain. The aim of this study was to determine whether topical ketamine is safe for cornea and evaluate its effect on the repair procedure the damaged corneal tissue. Our study was performed on only the right eyes of 15 male rats. All animals underwent general anesthesia and the whole corneal epithelium was removed. All subjects were divided into two groups: group 1 (n = 8), one drop of ketamine, and group 2 (n = 7), one drop of 0.9% sodium chloride administered topically on the scraped cornea every 6 h for 7 days. The rats' s cornea was carefully monitored daily for the size of epithelial defects under a microscope and was photographed. On the eighth day, the eyes were sent for pathological examination. The eyes were examined for the amount of inflammation, neovascularization, keratinization, epithelial thickness and Descemet's membrane pathologies. The epithelial defect has healed completely on the sixth day in all rats in both groups. There was no significant difference in the speed of complete recovery between the two groups. No significant difference was observed between the two groups in terms of inflammation grade, neovascularization grade, and epithelial thickness. Our study showed that topical ketamine had no significant effect on corneal wound healing in a rat animal model and could be used safely for the management of postoperative chronic ocular pain.
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Jung J, Kim T. General anesthesia and sleep: like and unlike. Anesth Pain Med (Seoul) 2022; 17:343-351. [DOI: 10.17085/apm.22227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
General anesthesia and sleep have long been discussed in the neurobiological context owingto their commonalities, such as unconsciousness, immobility, non-responsiveness to externalstimuli, and lack of memory upon returning to consciousness. Sleep is regulated bycomplex interactions between wake-promoting and sleep-promoting neural circuits. Anestheticsexert their effects partly by inhibiting wake-promoting neurons or activating sleep-promotingneurons. Unconscious but arousable sedation is more related to sleep-wake circuitries,whereas unconscious and unarousable anesthesia is independent of them. Generalanesthesia is notable for its ability to decrease sleep propensity. Conversely, increasedsleep propensity due to insufficient sleep potentiates anesthetic effects. Taken together, it isplausible that sleep and anesthesia are closely related phenomena but not the same ones.Further investigations on the relationship between sleep and anesthesia are warranted.
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Abuhelwa AY, Somogyi AA, Loo CK, Glue P, Barratt DT, Foster DJR. Population Pharmacokinetics and Pharmacodynamics of the Therapeutic and Adverse Effects of Ketamine in Patients with Treatment-Refractory Depression. Clin Pharmacol Ther 2022; 112:720-729. [PMID: 35560226 PMCID: PMC9540482 DOI: 10.1002/cpt.2640] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/30/2022] [Indexed: 02/06/2023]
Abstract
We aimed to develop population pharmacokinetic/pharmacodynamic (PK/PD) models that can effectively describe ketamine and norketamine PK/PD relationships for Montgomery–Åsberg Depression Rating Scale (MADRS) scores, blood pressure (BP), and heart rate (HR) following i.v., s.c., and i.m. ketamine administration in patients with treatment‐refractory depression. Ketamine PK/PD data were collected from 21 treatment‐refractory depressed participants who received ketamine (dose titration 0.1–0.5 mg/kg as single doses) by i.v., s.c., or i.m. administration. Model development used nonlinear mixed effect modeling. Ketamine and norketamine PK were best described using two‐compartment models with first‐order absorption after s.c. and i.m. administration. Estimated ketamine bioavailability after i.m. and s.c. was ~ 64% with indistinguishable first‐order absorption rate constants. Allometric scaling of body weight on all clearance and volumes of distribution improved the model fit. The delay in the concentration‐response relationship for MADRS scores was best described using a turnover model (turnover time ~ 42 hours), whereas for the BP and HR rates this was an immediate effect model. For all PD effects, ketamine alone was superior to models with norketamine concentration linked to an effect. No covariates were identified for PD effects. The estimated half‐maximal effective concentration from the MADRS score, BP, and HR were 0.44, 468, and 7,580 ng/mL, respectively. The integrated population models were able to effectively describe the PK/PD relationships for MADRS scores, BP, and HR after i.v., s.c., and i.m. ketamine administration. These findings allow for a deeper understanding of the complex relationships between route of ketamine administration and clinical response and safety.
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Affiliation(s)
- Ahmad Y Abuhelwa
- UniSA: Clinical and Health Sciences, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Andrew A Somogyi
- Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Colleen K Loo
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Black Dog Institute, Randwick, New South Wales, Australia
| | - Paul Glue
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Daniel T Barratt
- Discipline of Pharmacology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - David J R Foster
- UniSA: Clinical and Health Sciences, Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
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Procópio IM, Pereira-Sampaio MA, Costa WS, Sampaio FJB, Souza DBD. Histomorphometric comparison of the corpus cavernosum of rats submitted to euthanasia with ketamine and xylazine or isoflurane. Acta Cir Bras 2021; 36:e361103. [PMID: 34909838 PMCID: PMC8664359 DOI: 10.1590/acb361103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/09/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the penile histoarchitecture of rats euthanized with isoflurane or with ketamine and xylazine. METHODS Fourteen male rats were divided into two groups: ISO, with animals euthanized with isoflurane; and K+X, with animals euthanized with ketamine (150 mg/kg) associated with xylazine (15 mg/kg). Immediately after the death, the penises were dissected, fixed in a 4% buffered formalin solution, and processed for histomorphometric analysis. The surface densities (Sv) of the corpus cavernosum structures (connective tissue, smooth muscle, sinusoidal space, and elastic fibers) were evaluated using Image J software. The distribution of collagen types I and III was qualitatively assessed. Statistical analyses were performed using the Student's t test for data comparison, considering it statistically significant when p < 0.05. RESULTS Regarding the Sv of connective tissue, smooth muscle and sinusoidal space, there were no differences between animals in both groups. On the other hand, the animals euthanized with the association of ketamine and xylazine showed the Sv of elastic fibers 24.8% higher in relation to animals euthanized with isoflurane. CONCLUSIONS The euthanasia method affected one of the morphological parameters of the rat penises. The choice of euthanasia method must be standardized to reduce bias and to obtain reliable and reproducible results.
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Su L, Bai X, Niu T, Zhuang X, Dong B, Wang G, Yu Y. P2Y1 purinergic receptor inhibition attenuated remifentanil-induced postoperative hyperalgesia via decreasing NMDA receptor phosphorylation in dorsal root ganglion. Brain Res Bull 2021; 177:352-362. [PMID: 34653560 DOI: 10.1016/j.brainresbull.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Remifentanil-induced postoperative hyperalgesia is an intractable side effect of the clinical use of remifentanil, the mechanism of which remains obscure, especially in the peripheral nervous system. N-methyl-D-aspartate receptor (NMDAR) phosphorylation in dorsal root ganglion (DRG) plays a pronociceptive role in neuropathic pain. The contribution of the P2Y1 purinergic receptor (P2Y1R) in DRG to pain hypersensitivity derived from various origins and P2Y1R upregulation-induced NMDAR activation in neurons have also been uncovered. This study aimed to investigate whether P2Y1R participates in nociceptive processing in the DRG and spinal cord in remifentanil-induced postoperative hyperalgesia. METHODS Rats with remifentanil-induced postoperative hyperalgesia were intrathecally injected with NMDAR antagonist MK801 or P2Y1R antagonist MRS2179 at 10 min prior to remifentanil infusion. Mechanical allodynia, heat hyperalgesia, and cold hyperalgesia were measured at -24 h, 2 h, 6 h, 24 h, and 48 h following remifentanil infusion. The P2Y1R expression and NMDAR expression and phosphorylation in DRG ipsilateral to the incision were detected by Western blot and immunofluorescence. RESULTS Incision and remifentanil induced mechanical allodynia, heat hyperalgesia, and cold hyperalgesia accompanied by upregulated P2Y1R expression, increased NMDAR subunit NR1 expression and phosphorylation at Ser896, and NR2B expression and phosphorylation at Tyr1472 in DRG. Inhibition of NMDAR phosphorylation by MK801 effectively attenuated remifentanil-induced postoperative hyperalgesia. Furthermore, P2Y1R blockade by MRS2179 not only lessened remifentanil-evoked postoperative hypersensitivity to mechanical, heat, and cold stimuli, but also suppressed the increases in NR1 and NR2B expression and phosphorylation in DRG induced by incision and remifentanil. CONCLUSION The process by which P2Y1R mediates NMDAR expression and phosphorylation represents a mechanism of remifentanil-induced postoperative hyperalgesia in the DRG and/or spinal cord.
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Affiliation(s)
- Lin Su
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Xiaoqing Bai
- Department of Science and Education, Tianjin Beichen Hospital, No. 7 Beiyi Road, Beichen District, Tianjin 300400, PR China
| | - Tongxiang Niu
- Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Department of Anesthesiology, Tianjin Jinnan Hospital, No. 120 Jingu Road, Jinnan District, Tianjin 300350, PR China
| | - Xinqi Zhuang
- Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Department of Anesthesiology, Tianjin Medical University Second Hospital, No. 23 Pingjiang Road, Hexi District, Tianjin 300211, PR China
| | - Beibei Dong
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China.
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Su L, Bai X, Niu T, Zhuang X, Dong B, Li Y, Yu Y, Wang G. P2Y1 Purinergic Receptor Contributes to Remifentanil-Induced Cold Hyperalgesia via Transient Receptor Potential Melastatin 8-Dependent Regulation of N-methyl-d-aspartate Receptor Phosphorylation in Dorsal Root Ganglion. Anesth Analg 2021; 133:794-810. [PMID: 34166321 DOI: 10.1213/ane.0000000000005617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Remifentanil can induce postinfusion cold hyperalgesia. N-methyl-d-aspartate receptor (NMDAR) activation and upregulation of transient receptor potential melastatin 8 (TRPM8) membrane trafficking in dorsal root ganglion (DRG) are critical to cold hyperalgesia derived from neuropathic pain, and TRPM8 activation causes NMDAR-dependent cold response. Contribution of P2Y1 purinergic receptor (P2Y1R) activation in DRG to cold pain hypersensitivity and NMDAR activation induced by P2Y1R upregulation in neurons are also unraveled. This study explores whether P2Y1R contributes to remifentanil-induced cold hyperalgesia via TRPM8-dependent regulation of NMDAR phosphorylation in DRG. METHODS Rats with remifentanil-induced cold hyperalgesia were injected with TRPM8 antagonist or P2Y1R antagonist at 10 minutes before remifentanil infusion. Cold hyperalgesia (paw lift number and withdrawal duration on cold plate) was measured at -24, 2, 6, 24, and 48 hours following remifentanil infusion. After the last behavioral test, P2Y1R expression, TRPM8 expression and membrane trafficking, and NMDAR subunit (NR1 and NR2B) expression and phosphorylation in DRG were detected by western blot, and colocalization of P2Y1R with TRPM8 was determined by double-labeling immunofluorescence. Two-way repeated measures analysis of variance (ANOVA) or 2 × 2 factorial design ANOVA with repeated measures was used to analyze behavioral data of cold hyperalgesia. One-way ANOVA followed by Bonferroni post hoc comparisons was used to analyze the data in western blot and immunofluorescence. RESULTS Remifentanil infusion (1 μg·kg-1·min-1 for 60 minutes) induced cold hyperalgesia (hyperalgesia versus control, paw lift number and withdrawal duration on cold plate at 2-48 hours, P < .0001) with upregulated NR1 (hyperalgesia versus naive, 48 hours, mean ± standard deviation [SD], 114.00% ± 12.48% vs 41.75% ± 5.20%, P < .005) and NR2B subunits expression (104.13% ± 8.37% vs 24.63% ± 4.87%, P < .005), NR1 phosphorylation at Ser896 (91.88% ± 7.08% vs 52.00% ± 7.31%, P < .005) and NR2B phosphorylation at Tyr1472 (115.75% ± 8.68% vs 59.75% ± 7.78%, P < .005), TRPM8 expression (115.38% ± 9.27% vs 40.50% ± 4.07%, P < .005) and membrane trafficking (112.88% ± 5.62% vs 48.88% ± 6.49%, P < .005), and P2Y1R expression (128.25% ± 14.86% vs 45.13% ± 7.97%, P < .005) in DRG. Both TRPM8 and P2Y1R antagonists attenuated remifentanil-induced cold hyperalgesia and downregulated increased NR1 and NR2B expression and phosphorylation induced by remifentanil (remifentanil + RQ-00203078 versus remifentanil + saline, NR1 phosphorylation, 69.38% ± 3.66% vs 92.13% ± 4.85%; NR2B phosphorylation, 72.25% ± 6.43% vs 111.75% ± 11.00%, P < .0001). NMDAR activation abolished inhibition of TRPM8 and P2Y1R antagonists on remifentanil-induced cold hyperalgesia. P2Y1R antagonist inhibited remifentanil-evoked elevations in TRPM8 expression and membrane trafficking and P2Y1R-TRPM8 coexpression (remifentanil + 2'-deoxy-N6-methyl adenosine 3',5'-diphosphate [MRS2179] versus remifentanil + saline, coexpression, 8.33% ± 1.33% vs 22.19% ± 2.15%, P < .0001). CONCLUSIONS Attenuation of remifentanil-induced cold hyperalgesia by P2Y1R inhibition is attributed to downregulations in NMDAR expression and phosphorylation via diminishing TRPM8 expression and membrane trafficking in DRG.
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Affiliation(s)
- Lin Su
- From the Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
- Tianjin Research Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Xiaoqing Bai
- Department of Science and Education, Tianjin Beichen Hospital, Tianjin, People's Republic of China
| | - Tongxiang Niu
- Tianjin Research Institute of Anesthesiology, Tianjin, People's Republic of China
- Department of Anesthesiology, Tianjin Jinnan Hospital, Tianjin, People's Republic of China
| | - Xinqi Zhuang
- Tianjin Research Institute of Anesthesiology, Tianjin, People's Republic of China
- Department of Anesthesiology, Tianjin Medical University Second Hospital, Tianjin, People's Republic of China
| | - Beibei Dong
- From the Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
- Tianjin Research Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Yize Li
- From the Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
- Tianjin Research Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Yonghao Yu
- From the Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
- Tianjin Research Institute of Anesthesiology, Tianjin, People's Republic of China
| | - Guolin Wang
- From the Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
- Tianjin Research Institute of Anesthesiology, Tianjin, People's Republic of China
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Moon TS, Smith KM. Ketamine Use in the Surgical Patient: a Literature Review. Curr Pain Headache Rep 2021; 25:17. [PMID: 33630190 DOI: 10.1007/s11916-020-00930-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW While ketamine is an established anesthetic, its role in the management of acute surgical pain is less certain. Therefore, a literature review is warranted to examine the role of ketamine in acute pain management. RECENT FINDINGS The use of ketamine appears to be most efficacious in larger procedures that lead to increased systemic inflammation or extensive tissue damage. In addition, ketamine seems to be most successful when administered consistently throughout a procedure, such as by an infusion instead of a single bolus, in order to have adequate dosing for an analgesic effect. Therefore, the focus of research should be on procedures that lead to moderate to severe pain using frequent dosing to determine the most effective role of ketamine. Most importantly, the current literature shows that ketamine can be used as a successful part of multimodal anesthesia with few side effects in patients undergoing major procedures associated with moderate to severe pain.
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Affiliation(s)
- Tiffany S Moon
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA.
| | - Katelynn M Smith
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9068, USA
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Niu Y, Zeng X, Qin G, Zhang D, Zhou J, Chen L. Downregulation of metabotropic glutamate receptor 5 alleviates central sensitization by activating autophagy via inhibiting mTOR pathway in a rat model of chronic migraine. Neurosci Lett 2020; 743:135552. [PMID: 33352285 DOI: 10.1016/j.neulet.2020.135552] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
Central sensitization is one of the important pathological mechanisms of chronic migraine (CM). Metabolic glutamate receptor 5 (mGluR5) mediates pain by activating various intracellular pathways. However, whether mGluR5 contributes to central sensitization in CM and the exact mechanism remains unclear. Male rats were used to establish a CM model by repeated infusions of inflammatory soup (IS) for 7 days to stimulate the activation of the dural nociceptor. The mechanical and thermal thresholds were used to evaluate allodynia, and central sensitization was assessed by measuring calcitonin gene-related peptide (CGRP) and substance P (SP). Microtubule associated protein 1 light chain 3 (LC3) and p62/SQSTM1 were used to assess autophagy. We found that the expression of mGluR5 in the trigeminal nucleus caudalis (TNC) of CM rats was significantly increased. In addition, the downregulation of mGluR5 activated autophagy by inhibiting the mTOR pathway. Moreover, the activation of autophagy alleviated allodynia and central sensitization in CM rats. This study identified a novel strategy for the treatment of CM; the downregulation of mGluR5 in a rat model of CM decreased the expression of the inflammatory factor interleukin-1 beta (IL-1β) and the central sensitization-associated proteins CGRP and SP by activating autophagy via inhibiting the mTOR pathway.
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Affiliation(s)
- Yingying Niu
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoxu Zeng
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guangcheng Qin
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dunke Zhang
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lixue Chen
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Xu B, Wang Y, Zeng C, Wei J, Li J, Wu Z, He H, Lei G, Xie D, Ding X. Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies. BMJ Open 2019; 9:e028337. [PMID: 31519671 PMCID: PMC6747636 DOI: 10.1136/bmjopen-2018-028337] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine the analgesic efficacy and safety of ketamine after total knee or hip arthroplasty. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE and Cochrane Library from inception to 22 May 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing the efficacy and safety of ketamine with placebo for postoperative pain relief in patients undergoing total knee or hip arthroplasty. DATA EXTRACTION AND SYNTHESIS Data (ie, pain intensity, morphine consumption, gastrointestinal and psychotic adverse effects) were extracted by two reviewers independently. The Cochrane Collaboration's recommended tool was used to determine the methodological quality of included studies. RESULTS A total of 10 studies were included. One of them was rated as low quality. Compared with placebo, intravenous ketamine was effective for pain relief during 0-8-hour (weighted mean difference (WMD) -1.21, 95% CI -1.45 to -0.98, p<0.001; three studies, 149 participants) but not during 8-24-hour postoperative periods, and effective for reduction of cumulative morphine consumption during both 0-24-hour (WMD -17.76, 95% CI -31.25 to -4.27, p=0.01; five studies, 366 participants) and 0-48-hour (WMD -21.79, 95% CI -25.46 to -18.11, p<0.001; four studies, 252 participants) postoperative periods, without increasing risks of gastrointestinal or psychotic adverse effects. The limited data available for intra-articular (WMD -0.49, 95% CI -0.70 to -0.29, p<0.001; two studies, 83 participants) and epidural (WMD -2.10, 95% CI -3.30 to -0.90, p<0.001; one study, 20 participants) ketamine pointed to a significant reduction in pain intensity during 8-24-hour postoperative period. CONCLUSIONS Intravenous administration of ketamine is effective and safe for postoperative pain relief in patients undergoing total knee or hip arthroplasty. Nevertheless, the analgesic efficacy and safety of ketamine in such patients seem to vary by different administration routes and still warrant further studies to explore.
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Affiliation(s)
- Bei Xu
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yilun Wang
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Jiatian Li
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ziying Wu
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongyi He
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Dongxing Xie
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang Ding
- Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Hoffmann J, Storer RJ, Park JW, Goadsby PJ. N-Methyl-d-aspartate receptor open-channel blockers memantine and magnesium modulate nociceptive trigeminovascular neurotransmission in rats. Eur J Neurosci 2019; 50:2847-2859. [PMID: 31009120 DOI: 10.1111/ejn.14423] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 02/01/2023]
Abstract
Experimental and clinical studies suggest that the low-affinity N-methyl-d-aspartate (NMDA) receptor open-channel blockers Mg2+ and memantine are effective in reducing trigeminal nociceptive activation. The aim of this study was to investigate the apparent effectiveness of these channel blockers using a model of trigeminal activation in vivo. Rats were anaesthetized before electrically stimulating the dura mater adjacent the middle meningeal artery. Neurons responding to stimulation were recorded extracellularly using electrophysiological methods. l-Glutamate or NMDA, and Mg2+ , memantine, or sodium controls were applied locally using microiontophoresis. Microiontophoretic application of Mg2+ or memantine into the trigeminocervical complex inhibited mechanically and electrically stimulated craniovascular afferents, and l-glutamate or NMDA-evoked neuronal activity at the second-order trigeminal synapse of craniovascular afferents. By contrast, intravenous administration of MgSO4 (100 mg/kg) or memantine (10 mg/kg) did not significantly affect electrically stimulated afferent-evoked activity within the trigeminocervical complex. The Mg2+ and memantine concentrations achieved after systemic administration may not effectively inhibit activation of the trigeminocervical complex, perhaps providing an explanation for the relatively poor efficacy of these NMDA receptor open-channel blockers for headache treatment in clinical studies. Nevertheless, the present results suggest blocking of NMDA-receptor open channels inhibits nociceptive activation of the trigeminocervical complex. Further exploration of such channel blockers as a therapeutic strategy for primary head pain is warranted.
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Affiliation(s)
- Jan Hoffmann
- Department of Neurology, University of California, San Francisco, California, USA.,Headache Group, Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin James Storer
- Department of Neurology, University of California, San Francisco, California, USA.,Office of Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jeong-Wook Park
- Department of Neurology, Catholic University, Seoul, South Korea
| | - Peter J Goadsby
- Department of Neurology, University of California, San Francisco, California, USA.,Headache Group, Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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Thompson T, Terhune DB, Oram C, Sharangparni J, Rouf R, Solmi M, Veronese N, Stubbs B. The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials. Neurosci Biobehav Rev 2019; 99:298-310. [DOI: 10.1016/j.neubiorev.2019.02.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 02/11/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
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13
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Pickering G, Morel V, Micallef J. Kétamine et douleur chronique : une revue narrative de son efficacité et sécurité. Therapie 2018; 73:529-539. [DOI: 10.1016/j.therap.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/27/2018] [Accepted: 06/12/2018] [Indexed: 01/19/2023]
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14
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Jiang Y, Chen R, Xu S, Li J, Yu F, Kong L, Sun Y, Ye Y, Li Y, Yu M, Wu J. The impact of prophylactic dexamethasone on postoperative sore throat: an updated systematic review and meta-analysis. J Pain Res 2018; 11:2463-2475. [PMID: 30425559 PMCID: PMC6204848 DOI: 10.2147/jpr.s172419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS An updated systematic review and meta-analysis was conducted to assess the effect of prophylactic dexamethasone for tracheal intubation of general anesthesia on postoperative sore throat (POST). METHODS Comprehensive literature search of databases for randomized controlled trials (RCTs), including Embase, PubMed, and Cochrane Library, which evaluate the effect of prophylactic dexamethasone on POST was conducted. RevMan 5.0 and STATA 12.0 software were used to perform meta-analyses. RESULTS Fourteen RCTs totaling 1,837 patients were included for analysis. Compared with placebo, a significant reduction in the incidence of POST (OR 0.44, 95% CI 0.33-0.58, P<0.00001), hoarseness (OR 0.42, 95% CI 0.31-0.58, P<0.00001), and postoperative nausea and vomiting (PONV) (OR 0.06, 95% CI 0.03-0.14, P<0.00001) and a comparable incidence of cough (OR 0.59, 95% CI 0.19-1.89, P=0.38) was described in patients receiving dexamethasone, with or without concomitant drugs. Dexamethasone ≥0.2 mg/kg had a statistically greater impact on reducing the incidence of POST than dexamethasone 0.1-0.2 mg/kg, while dexamethasone ≤0.1 mg/kg did not. Dexamethasone was as effective as other drugs such as ondansetron, magnesium sulfate, ketamine gargle, betamethasone gel, and ketorolac for reducing POST (OR 0.70, 95% CI 0.46-1.07, P=0.10). Dexamethasone plus a different drug was more effective than dexamethasone alone for reducing the incidence of POST at 24 hours (OR 0.40, 95% CI 0.21-0.77, P=0.006). Compared with controls, a statistically higher blood glucose level was the only adverse event during the immediate postoperative period in patients receiving dexamethasone. CONCLUSIONS Intravenous dexamethasone ≥0.2 mg/kg within 30 minutes before or after induction of general anesthesia should be recommended as grade 1A evidence with safety and efficacy in reducing the incidence of POST, hoarseness, and PONV in patients without pregnancy, diabetes mellitus, or contraindications for corticosteroids.
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Affiliation(s)
- Yaofei Jiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jiaxing University, Jiaxing, China,
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
- Hubei Cancer Clinical Study Centre
- Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital, Wuhan, China
| | - Ruoxi Chen
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Suming Xu
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Jiaxi Li
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Fanqi Yu
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Lingdong Kong
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Yuhan Sun
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Yuan Ye
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Yimin Li
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Mengqi Yu
- Department of General Surgery, The Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Jiaming Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jiaxing University, Jiaxing, China,
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15
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Patterson DR, Hoffer C, Jensen MP, Wiechman SA, Sharar SR. KETAMINE AS A POSSIBLE MODERATOR OF HYPNOTIZABILITY: A FEASIBILITY STUDY. Int J Clin Exp Hypn 2018; 66:298-307. [PMID: 29856288 PMCID: PMC6181123 DOI: 10.1080/00207144.2018.1460559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This pilot study explored the feasibility of using ketamine to increase hypnotizability scores. Ketamine, classified as a dissociative hallucinogen, is used clinically as an anesthetic in high doses and as a treatment for chronic pain and depression in lower doses. Low-dose ketamine can contribute to dissociation and heightened perceptions and feelings of detachment, arguably hypnotic-like states. The authors predicted that a low dose of ketamine in healthy volunteers who scored in the low hypnotizable range on the Stanford Clinical Hypnotizability Scale would (a) cause an increase in subjective ratings of dissociation and (b) lead to an increase in hypnotizability. The findings were in the predicted direction, warranting further investigation into the use of this agent to increase hypnotizability.
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Affiliation(s)
| | | | - Mark P Jensen
- a University of Washington School of Medicine , Seattle , USA
| | | | - Sam R Sharar
- a University of Washington School of Medicine , Seattle , USA
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16
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COMPARATIVE STUDY BETWEEN INTRAVENOUS DEXAMETHASONE VERSUS KETAMINE GARGLE VERSUS INTRAVENOUS DEXAMETHASONE COMBINED WITH KETAMINE GARGLE FOR EVALUATION OF POST-OPERATIVE SORE THROAT AND HOARSENESS IN MIDDLE EAR SURGERY. ACTA ACUST UNITED AC 2018. [DOI: 10.14260/jemds/2018/370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Choi SK, Yoon MH, Choi JI, Kim WM, Heo BH, Park KS, Song JA. Comparison of effects of intraoperative nefopam and ketamine infusion on managing postoperative pain after laparoscopic cholecystectomy administered remifentanil. Korean J Anesthesiol 2016; 69:480-486. [PMID: 27703629 PMCID: PMC5047984 DOI: 10.4097/kjae.2016.69.5.480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although intraoperative opioids provide more comfortable anesthesia and reduce the use of postoperative analgesics, it may cause opioid induced hyperalgesia (OIH). OIH is an increased pain response to opioids and it may be associated with N-methyl-D-aspartate (NMDA) receptor. This study aimed to determine whether intraoperative nefopam or ketamine, known being related on NMDA receptor, affects postoperative pain and OIH after continuous infusion of intraoperative remifentanil. METHODS Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. In the nefopam group (N group), patients received nefopam 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 0.065 mg/kg/h. In the ketamine group (K group), patients received ketamine 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 3 µg/kg/min. The control group did not received any other agents except for the standard anesthetic regimen. Postoperative pain score, first time and number of demanding rescue analgesia, OIH and degrees of drowsiness/sedation scale were examined. RESULTS Co-administrated nefopam or ketamine significantly reduced the total amount of intraoperative remifentanil and postoperative supplemental morphine. Nefopam group showed superior property over control and ketamine group in the postoperative VAS score and recovery index (alertness and respiratory drive), respectively. Nefopam group showed lower morphine consumption than ketamine group, but not significant. CONCLUSIONS Both nefopam and ketamine infusion may be useful in managing in postoperative pain control under concomitant infusion of remifentanil. However, nefopam may be preferred to ketamine in terms of sedation.
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Affiliation(s)
- Sung Kwan Choi
- Department of Anesthesiology and Pain Medicine, Gwangju Christian Hospital, Gwangju, Korea
| | - Myung Ha Yoon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Il Choi
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Woong Mo Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Bong Ha Heo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Keun Seok Park
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Ji A Song
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, Korea
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18
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Zhao Q, Zhang L, Shu R, Wang C, Yu Y, Wang H, Wang G. Involvement of Spinal PKMζ Expression and Phosphorylation in Remifentanil-Induced Long-Term Hyperalgesia in Rats. Cell Mol Neurobiol 2016; 37:643-653. [PMID: 27380044 DOI: 10.1007/s10571-016-0401-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Up-regulation of GluN2B-containing N-methyl-D-aspartate receptors (NMDARs) expression and trafficking is the key mechanism for remifentanil-induced hyperalgesia (RIH), nevertheless, the signaling pathway and pivotal proteins involved in RIH remain equivocal. PKMζ, an isoform of protein kinase C (PKC), maintains pain memory storage in neuropathic pain and inflammatory pain, which plays a parallel role regulated by NMDARs in long-term memory trace. In the present study, Zeta Inhibitory Peptide (ZIP), a PKMζ inhibitor, and a selective GluN2B antagonist Ro-256981 are injected intrathecally before remifentanil infusion (1 μg kg-1 min-1 for 1 h, iv) in order to detect whether GluN2B contributes to RIH through affecting synthesis and activity of PKMζ in spinal dorsal horn. Nociceptive tests are measured by Paw withdrawal mechanical threshold (PWT) and paw withdrawal thermal latency (PWL). The L4-L6 segments of dorsal horn taken from rats with RIH are for determining expression of PKMζ and pPKMζ by Western blot and immunohistochemistry. Our data suggest that remifentanil infusion causes an increase of PKMζ in expression and phosphorylation in rats with nociceptive sensitization, beginning at 2 h, peaked at 2 days, and returned to basal level at 7 days. ZIP (10 ng) could block behavioral sensitization induced by remifentanil. Ro25-6981 dosage-dependently attenuated mechanical and thermal hyperalgesia and reversed expression of PKMζ and pPKMζ, indicating that GluN2B-containing NMDA receptor facilitates development of RIH through mediating expression and activity of spinal PKMζ in rats. Although detailed mechanisms require further comprehensive study, the preventive role of Ro25-6981 and ZIP provide novel options for the effective precaution of RIH in clinics.
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Affiliation(s)
- Qi Zhao
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Linlin Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Ruichen Shu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Chunyan Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Haiyun Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China. .,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China.
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19
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Gao M, Rejaei D, Liu H. Ketamine use in current clinical practice. Acta Pharmacol Sin 2016; 37:865-72. [PMID: 27018176 DOI: 10.1038/aps.2016.5] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 01/19/2016] [Indexed: 12/14/2022] Open
Abstract
After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.
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20
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Yang LH, Xu GM, Wang Y. Up-regulation of CXCL1 and CXCR2 contributes to remifentanil-induced hypernociception via modulating spinal NMDA receptor expression and phosphorylation in rats. Neurosci Lett 2016; 626:135-41. [DOI: 10.1016/j.neulet.2015.12.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/04/2015] [Accepted: 12/15/2015] [Indexed: 11/27/2022]
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21
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Gorlin AW, Rosenfeld DM, Ramakrishna H. Intravenous sub-anesthetic ketamine for perioperative analgesia. J Anaesthesiol Clin Pharmacol 2016; 32:160-7. [PMID: 27275042 PMCID: PMC4874067 DOI: 10.4103/0970-9185.182085] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ketamine, an N-methyl-d-aspartate antagonist, blunts central pain sensitization at sub-anesthetic doses (0.3 mg/kg or less) and has been studied extensively as an adjunct for perioperative analgesia. At sub-anesthetic doses, ketamine has a minimal physiologic impact though it is associated with a low incidence of mild psychomimetic symptoms as well as nystagmus and double vision. Contraindications to its use do exist and due to ketamine's metabolism, caution should be exercised in patients with renal or hepatic dysfunction. Sub-anesthetic ketamine improves pain scores and reduces perioperative opioid consumption in a broad range of surgical procedures. In addition, there is evidence that ketamine may be useful in patients with opioid tolerance and for preventing chronic postsurgical pain.
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Affiliation(s)
- Andrew W Gorlin
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - David M Rosenfeld
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Harish Ramakrishna
- Department of Anesthesiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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22
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Prenatal ketamine exposure causes abnormal development of prefrontal cortex in rat. Sci Rep 2016; 6:26865. [PMID: 27226073 PMCID: PMC4881038 DOI: 10.1038/srep26865] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 05/09/2016] [Indexed: 01/25/2023] Open
Abstract
Ketamine is commonly used for anesthesia and as a recreational drug. In pregnant users, a potential neurotoxicity in offspring has been noted. Our previous work demonstrated that ketamine exposure of pregnant rats induces affective disorders and cognitive impairments in offspring. As the prefrontal cortex (PFC) is critically involved in emotional and cognitive processes, here we studied whether maternal ketamine exposure influences the development of the PFC in offspring. Pregnant rats on gestational day 14 were treated with ketamine at a sedative dose for 2 hrs, and pups were studied at postnatal day 0 (P0) or P30. We found that maternal ketamine exposure resulted in cell apoptosis and neuronal loss in fetal brain. Upon ketamine exposure in utero, PFC neurons at P30 showed more dendritic branching, while cultured neurons from P0 PFC extended shorter neurites than controls. In addition, maternal ketamine exposure postponed the switch of NR2B/2A expression, and perturbed pre- and postsynaptic protein expression in the PFC. These data suggest that prenatal ketamine exposure impairs neuronal development of the PFC, which may be associated with abnormal behavior in offsprings.
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23
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δ-Ctenitoxin-Pn1a, a Peptide from Phoneutria nigriventer Spider Venom, Shows Antinociceptive Effect Involving Opioid and Cannabinoid Systems, in Rats. Toxins (Basel) 2016; 8:106. [PMID: 27077886 PMCID: PMC4848632 DOI: 10.3390/toxins8040106] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/13/2023] Open
Abstract
PnTx4(6-1), henceforth renamed δ-Ctenitoxin-Pn1a (δ-CNTX-Pn1a), a peptide from Phoneutria nigriventer spider venom, initially described as an insect toxin, binds to site 3 of sodium channels in nerve cord synaptosomes and slows down sodium current inactivation in isolated axons in cockroaches (Periplaneta americana). δ-CNTX-Pn1a does not cause any apparent toxicity to mice, when intracerebroventricularly injected (30 μg). In this study, we evaluated the antinociceptive effect of δ-CNTX-Pn1a in three animal pain models and investigated its mechanism of action in acute pain. In the inflammatory pain model, induced by carrageenan, δ-CNTX-Pn1a restored the nociceptive threshold of rats, when intraplantarly injected, 2 h and 30 min after carrageenan administration. Concerning the neuropathic pain model, δ-CNTX-Pn1a, when intrathecally administered, reversed the hyperalgesia evoked by sciatic nerve constriction. In the acute pain model, induced by prostaglandin E2, intrathecal administration of δ-CNTX-Pn1a caused a dose-dependent antinociceptive effect. Using antagonists of the receptors, we showed that the antinociceptive effect of δ-CNTX-Pn1a involves both the cannabinoid system, through CB1 receptors, and the opioid system, through μ and δ receptors. Our data show, for the first time, that δ-Ctenitoxin-Pn1a is able to induce antinociception in inflammatory, neuropathic and acute pain models.
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24
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In vivo activation of the SK channel in the spinal cord reduces the NMDA receptor antagonist dose needed to produce antinociception in an inflammatory pain model. Pain 2016; 156:849-858. [PMID: 25734988 DOI: 10.1097/j.pain.0000000000000124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
N-methyl-D-aspartate receptor (NMDAR) antagonists have been shown to reduce mechanical hypersensitivity in animal models of inflammatory pain. However, their clinical use is associated with significant dose-limiting side effects. Small-conductance Ca-activated K channels (SK) have been shown to modulate NMDAR activity in the brain. We demonstrate that in vivo activation of SK channels in the spinal cord can alleviate mechanical hypersensitivity in a rat model of inflammatory pain. Intrathecal (i.t.) administration of the SK channel activator, 6,7-dichloro-1H-indole-2,3-dione 3-oxime (NS309), attenuates complete Freund adjuvant (CFA)-induced mechanical hypersensitivity in a dose-dependent manner. Postsynaptic expression of the SK channel subunit, SK3, and apamin-sensitive SK channel-mediated currents recorded from superficial laminae are significantly reduced in the dorsal horn (DH) after CFA. Complete Freund adjuvant-induced decrease in SK-mediated currents can be reversed in vitro by bath application of NS309. In addition, immunostaining for the SK3 subunit indicates that SK3-containing channels within DH neurons can have both somatic and dendritic localization. Double immunostaining shows coexpression of SK3 and NMDAR subunit, NR1, compatible with functional interaction. Moreover, we demonstrate that i.t. coadministration of NS309 with an NMDAR antagonist reduces the dose of NMDAR antagonist, DL-2-amino-5-phosphonopentanoic acid (DL-AP5), required to produce antinociceptive effects in the CFA model. This reduction could attenuate the unwanted side effects associated with NMDAR antagonists, giving this combination potential clinical implications.
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25
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Chiechio S. Modulation of Chronic Pain by Metabotropic Glutamate Receptors. PHARMACOLOGICAL MECHANISMS AND THE MODULATION OF PAIN 2016; 75:63-89. [DOI: 10.1016/bs.apha.2015.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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26
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Lodge D, Mercier MS. Ketamine and phencyclidine: the good, the bad and the unexpected. Br J Pharmacol 2015; 172:4254-76. [PMID: 26075331 DOI: 10.1111/bph.13222] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 12/21/2022] Open
Abstract
The history of ketamine and phencyclidine from their development as potential clinical anaesthetics through drugs of abuse and animal models of schizophrenia to potential rapidly acting antidepressants is reviewed. The discovery in 1983 of the NMDA receptor antagonist property of ketamine and phencyclidine was a key step to understanding their pharmacology, including their psychotomimetic effects in man. This review describes the historical context and the course of that discovery and its expansion into other hallucinatory drugs. The relevance of these findings to modern hypotheses of schizophrenia and the implications for drug discovery are reviewed. The findings of the rapidly acting antidepressant effects of ketamine in man are discussed in relation to other glutamatergic mechanisms.
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Affiliation(s)
- D Lodge
- Centre for Synaptic Plasticity, School of Physiology and Pharmacology, University of Bristol, Bristol, UK
| | - M S Mercier
- Centre for Synaptic Plasticity, School of Physiology and Pharmacology, University of Bristol, Bristol, UK
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27
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Han SS, Do SH, Kim TH, Choi WJ, Yun JS, Ryu JH. Stepwise tapering of remifentanil at the end of surgery decreased postoperative pain and the need of rescue analgesics after thyroidectomy. BMC Anesthesiol 2015; 15:46. [PMID: 25927221 PMCID: PMC4404040 DOI: 10.1186/s12871-015-0026-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was designed to investigate whether stepwise tapering of remifentanil at the end of surgery could decrease postoperative pain scores and requirements of rescue analgesics after remifentanil-desflurane anesthesia in patients with thyroidectomy. METHODS Sixty two patients undergoing thyroidectomy under general anesthesia were randomly allocated into two groups. All patients were anesthetised with desflurane and high-dose remifentanil. Remifentnail was infused at the rate of 0.3 μg/kg/min until the end of surgery in patients of the control group (group A) whereas remifentanil was tapered gradually from 0.3 to 0.1 μg/kg/min until the end of surgery for at least 30 minutes in patients with group B. Pain scores (0-100 numerical rating scale, NRS), rescue analgesic requirements and adverse events were assessed at 30 min, 2 h, 6 h, 12 h, and 24 h after operation. RESULTS There was a significant decrease in pain scores at 30 min (20 [0-80] vs. 50 [0-100], P = 0.002) and 2 h (30 [10-60] vs. 40 [20-80], P = 0.018) after surgery in group B compared with group A. In addition, rescue analgesics are less required in group B than in group A postoperatively (2 [1-3] vs. 3 [2,3], P = 0.039). There were no significant differences in adverse events between the two groups. CONCLUSIONS Tapering of remifentanil at the end of surgery decreased postoperative pain scores immediately after thyroidectomy with desflurane and high-dose remifentanil anesthesia. TRIAL REGISTRATION Clinical Research information Service (CRiS, registration number KCT0000589).
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Affiliation(s)
- Sun Sook Han
- Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Sang Hwan Do
- Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
| | - Tae Hee Kim
- Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Won Joon Choi
- Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Ji Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Jung Hee Ryu
- Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
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28
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van Loon AM, Fahrenfort JJ, van der Velde B, Lirk PB, Vulink NCC, Hollmann MW, Scholte HS, Lamme VAF. NMDA Receptor Antagonist Ketamine Distorts Object Recognition by Reducing Feedback to Early Visual Cortex. Cereb Cortex 2015; 26:1986-96. [PMID: 25662715 DOI: 10.1093/cercor/bhv018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is a well-established fact that top-down processes influence neural representations in lower-level visual areas. Electrophysiological recordings in monkeys as well as theoretical models suggest that these top-down processes depend on NMDA receptor functioning. However, this underlying neural mechanism has not been tested in humans. We used fMRI multivoxel pattern analysis to compare the neural representations of ambiguous Mooney images before and after they were recognized with their unambiguous grayscale version. Additionally, we administered ketamine, an NMDA receptor antagonist, to interfere with this process. Our results demonstrate that after recognition, the pattern of brain activation elicited by a Mooney image is more similar to that of its easily recognizable grayscale version than to the pattern evoked by the identical Mooney image before recognition. Moreover, recognition of Mooney images decreased mean response; however, neural representations of separate images became more dissimilar. So from the neural perspective, unrecognizable Mooney images all "look the same", whereas recognized Mooneys look different. We observed these effects in posterior fusiform part of lateral occipital cortex and in early visual cortex. Ketamine distorted these effects of recognition, but in early visual cortex only. This suggests that top-down processes from higher- to lower-level visual areas might operate via an NMDA pathway.
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Affiliation(s)
- Anouk M van Loon
- Department of Brain and Cognition, University of Amsterdam, Amsterdam 1018 XA, The Netherlands Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam 1018 WS, The Netherlands Department of Cognitive Psychology, VU University, Amsterdam 1081 BT, The Netherlands
| | - Johannes J Fahrenfort
- Department of Cognitive Psychology, VU University, Amsterdam 1081 BT, The Netherlands
| | - Bauke van der Velde
- Department of Brain and Cognition, University of Amsterdam, Amsterdam 1018 XA, The Netherlands
| | - Philipp B Lirk
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam 1105 DD, The Netherlands
| | - Nienke C C Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands
| | - Markus W Hollmann
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam 1105 DD, The Netherlands
| | - H Steven Scholte
- Department of Brain and Cognition, University of Amsterdam, Amsterdam 1018 XA, The Netherlands Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam 1018 WS, The Netherlands
| | - Victor A F Lamme
- Department of Brain and Cognition, University of Amsterdam, Amsterdam 1018 XA, The Netherlands Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam 1018 WS, The Netherlands
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Lee JH, Wei ZZ, Chen D, Gu X, Wei L, Yu SP. A neuroprotective role of the NMDA receptor subunit GluN3A (NR3A) in ischemic stroke of the adult mouse. Am J Physiol Cell Physiol 2015; 308:C570-7. [PMID: 25652449 DOI: 10.1152/ajpcell.00353.2014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 02/02/2015] [Indexed: 11/22/2022]
Abstract
GluN3A or NR3A is a developmentally regulated N-methyl-d-aspartate receptor (NMDAR) subunit, showing a unique inhibitory role that decreases NMDAR current and the receptor-mediated Ca(2+) influx. In the neonatal brain, GluN3A is shown to associate with synaptic maturation and spine formation and plays a neuroprotective role. Its functional role in the adult brain, however, is largely unknown. We tested the hypothesis that, disrespecting the relatively lower expression level of GluN3A in the adult brain, this inhibitory NMDAR subunit shows a protective action against ischemia-induced brain injury. In littermate wild-type (WT) and GluN3A knockout (KO) mice, focal cerebral ischemia was induced by permanent occlusion of right distal branches of the middle cerebral artery (MCA) plus 10-min ligation of both common carotid arteries (CCAs). Twenty-four hours after focal cerebral ischemia, the infarction volume assessed using 2,3,5-triphenyltetrazolium chloride (TTC) staining was significantly larger in GluN3A KO mice compared with WT mice. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining demonstrated enhanced cell death in GluN3A KO mice. Moreover, the deletion of GluN3A hindered sensorimotor functional recovery after stroke. It is suggested that, although the expression level is relatively lower in the adult brain, GluN3A is still a noteworthy regulator in ischemia-induced excitotoxicity and brain injury.
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Affiliation(s)
- Jin Hwan Lee
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; and
| | - Zheng Z Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; and Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Dongdong Chen
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; and Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Xiaohuan Gu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; and Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Ling Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; and Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Shan Ping Yu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia; and Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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Yang L, Zhang J, Zhang Z, Zhang C, Zhao D, Li J. Preemptive analgesia effects of Ketamine in patients undergoing surgery. A meta-analysis. Acta Cir Bras 2014; 29:819-25. [DOI: 10.1590/s0102-86502014001900009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/21/2014] [Indexed: 01/03/2023] Open
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Hydrogen-rich saline prevents remifentanil-induced hyperalgesia and inhibits MnSOD nitration via regulation of NR2B-containing NMDA receptor in rats. Neuroscience 2014; 280:171-80. [DOI: 10.1016/j.neuroscience.2014.09.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/31/2014] [Accepted: 09/10/2014] [Indexed: 11/22/2022]
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Safavi M, Honarmand A, Fariborzifar A, Attari M. Intravenous dexamethasone versus ketamine gargle versus intravenous dexamethasone combined with ketamine gargle for evaluation of post-operative sore throat and hoarseness: A randomized, placebo-controlled, double blind clinical trial. Adv Biomed Res 2014; 3:212. [PMID: 25371869 PMCID: PMC4219209 DOI: 10.4103/2277-9175.143257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 05/18/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Sore throat and hoarseness are the most frequent subjective complaints after tracheal intubation for general anesthesia. We conducted a prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intravenous (IV) dexamethasone plus ketamine gargle for reducing the incidence and severity of post-operative sore throat (POST) and hoarseness. MATERIALS AND METHODS 140 patients (aged 16-65 year) scheduled for elective surgery were enrolled. Patients were randomly allocated into four groups of 35 subjects each: Group K, gargled 40 mg ketamine in 30 ml saline; Group D, were infused 0.2 mg/kg IV dexamethasone; Group KD, gargled 40 mg ketamine in 30 ml saline plus 0.2 mg/kg IV dexamethasone; Group P (placebo) that received saline (gargle and IV). POST was graded at 0, 2, 4, 8, 16 and 24 h after operation on a four-point scale (0-3). RESULTS The incidence and severity of POST were significantly lower in Group KD, compared with the other groups at all times after tracheal extubation for up to 24 h (P < 0.05). Also the incidence and severity of hoarseness were significantly lower in each Groups of KD and K and D compared with group placebo (P < 0.05). CONCLUSION The prophylactic use of 0.2 mg/kg of IV dexamethasone plus ketamine gargle significantly reduced the incidence and severity of POST compared with using each of these drugs alone or using placebo.
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Affiliation(s)
- Mohammadreza Safavi
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arghavan Fariborzifar
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadali Attari
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Pickering AE, McCabe CS. Prolonged ketamine infusion as a therapy for complex regional pain syndrome: synergism with antagonism? Br J Clin Pharmacol 2014; 77:233-8. [PMID: 23701138 PMCID: PMC3992840 DOI: 10.1111/bcp.12157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/28/2013] [Indexed: 12/18/2022] Open
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O’Brien SL, Pangarkar S, Prager J. The Use of Ketamine in Neuropathic Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0045-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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36
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Lee MH, Chung MH, Han CS, Lee JH, Choi YR, Choi EM, Lim HK, Cha YD. Comparison of effects of intraoperative esmolol and ketamine infusion on acute postoperative pain after remifentanil-based anesthesia in patients undergoing laparoscopic cholecystectomy. Korean J Anesthesiol 2014; 66:222-9. [PMID: 24729845 PMCID: PMC3983419 DOI: 10.4097/kjae.2014.66.3.222] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Remifentanil is a short-acting drug with a rapid onset that is useful in general anesthesia. Recently, however, it has been suggested that the use of opioids during surgery may cause opioid-induced hyperalgesia (OIH). Researchers have recently reported that esmolol, an ultra-short-acing β1 receptor antagonist, reduces the postoperative requirement for morphine and provides more effective analgesia than the administration of remifentanil and ketamine. Hence, this study was conducted to determine whether esmolol reduces early postoperative pain in patients who are continuously infused with remifentanil for anesthesia during laparoscopic cholecystectomy. METHODS Sixty patients scheduled to undergo laparoscopic cholecystectomy were randomly divided into three groups. Anesthesia was maintained with sevoflurane and 4 ng/ml (target-controlled infusion) of remifentanil in all patients. Esmolol (0.5 mg/kg) was injected and followed with a continuous dosage of 10 µg/kg/min in the esmolol group (n = 20). Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µg/kg/min in the ketamine group (n = 20), while the control group was injected and infused with an equal amount of normal saline. Postoperative pain score (visual analog scale [VAS]) and analgesic requirements were compared for the first 6 hours of the postoperative period. RESULTS The pain score (VAS) and fentanyl requirement for 15 minutes after surgery were lower in the esmolol and ketamine groups compared with the control group (P < 0.05). There were no differences between the esmolol and ketamine groups. CONCLUSIONS Intraoperative esmolol infusion during laparoscopic cholecystectomy reduced opioid requirement and pain score (VAS) during the early postoperative period after remifentanil-based anesthesia.
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Affiliation(s)
- Mi Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Mi Hwa Chung
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Cheol Sig Han
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Ryong Choi
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Mi Choi
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Kyung Lim
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young Duk Cha
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
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Dicpinigaitis PV, Morice AH, Birring SS, McGarvey L, Smith JA, Canning BJ, Page CP. Antitussive drugs--past, present, and future. Pharmacol Rev 2014; 66:468-512. [PMID: 24671376 PMCID: PMC11060423 DOI: 10.1124/pr.111.005116] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Cough remains a serious unmet clinical problem, both as a symptom of a range of other conditions such as asthma, chronic obstructive pulmonary disease, gastroesophageal reflux, and as a problem in its own right in patients with chronic cough of unknown origin. This article reviews our current understanding of the pathogenesis of cough and the hypertussive state characterizing a number of diseases as well as reviewing the evidence for the different classes of antitussive drug currently in clinical use. For completeness, the review also discusses a number of major drug classes often clinically used to treat cough but that are not generally classified as antitussive drugs. We also reviewed a number of drug classes in various stages of development as antitussive drugs. Perhaps surprising for drugs used to treat such a common symptom, there is a paucity of well-controlled clinical studies documenting evidence for the use of many of the drug classes in use today, particularly those available over the counter. Nonetheless, there has been a considerable increase in our understanding of the cough reflex over the last decade that has led to a number of promising new targets for antitussive drugs being identified and thus giving some hope of new drugs being available in the not too distant future for the treatment of this often debilitating symptom.
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Affiliation(s)
- P V Dicpinigaitis
- King's College London, Franklin Wilkins Building, 100 Stamford St., London, SE1 9NH, UK.
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Wang LL, Chen D, Lee J, Gu X, Alaaeddine G, Li J, Wei L, Yu SP. Mobilization of endogenous bone marrow derived endothelial progenitor cells and therapeutic potential of parathyroid hormone after ischemic stroke in mice. PLoS One 2014; 9:e87284. [PMID: 24503654 PMCID: PMC3913619 DOI: 10.1371/journal.pone.0087284] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/20/2013] [Indexed: 12/19/2022] Open
Abstract
Stroke is a major neurovascular disorder threatening human life and health. Very limited clinical treatments are currently available for stroke patients. Stem cell transplantation has shown promising potential as a regenerative treatment after ischemic stroke. The present investigation explores a new concept of mobilizing endogenous stem cells/progenitor cells from the bone marrow using a parathyroid hormone (PTH) therapy after ischemic stroke in adult mice. PTH 1-34 (80 µg/kg, i.p.) was administered 1 hour after focal ischemia and then daily for 6 consecutive days. After 6 days of PTH treatment, there was a significant increase in bone marrow derived CD-34/Fetal liver kinase-1 (Flk-1) positive endothelial progenitor cells (EPCs) in the peripheral blood. PTH treatment significantly increased the expression of trophic/regenerative factors including VEGF, SDF-1, BDNF and Tie-1 in the brain peri-infarct region. Angiogenesis, assessed by co-labeled Glut-1 and BrdU vessels, was significantly increased in PTH-treated ischemic brain compared to vehicle controls. PTH treatment also promoted neuroblast migration from the subventricular zone (SVZ) and increased the number of newly formed neurons in the peri-infarct cortex. PTH-treated mice showed significantly better sensorimotor functional recovery compared to stroke controls. Our data suggests that PTH therapy improves endogenous repair mechanisms after ischemic stroke with functional benefits. Mobilizing endogenous bone marrow-derived stem cells/progenitor cells using PTH and other mobilizers appears an effective and feasible regenerative treatment after ischemic stroke.
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Affiliation(s)
- Li-Li Wang
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Dongdong Chen
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jinhwan Lee
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Xiaohuan Gu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Ghina Alaaeddine
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Jimei Li
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ling Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Shan Ping Yu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, United States of America
- * E-mail:
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Meuwese JDI, van Loon AM, Scholte HS, Lirk PB, Vulink NCC, Hollmann MW, Lamme VAF. NMDA receptor antagonist ketamine impairs feature integration in visual perception. PLoS One 2013; 8:e79326. [PMID: 24223927 PMCID: PMC3815103 DOI: 10.1371/journal.pone.0079326] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 09/22/2013] [Indexed: 11/28/2022] Open
Abstract
Recurrent interactions between neurons in the visual cortex are crucial for the integration of image elements into coherent objects, such as in figure-ground segregation of textured images. Blocking N-methyl-D-aspartate (NMDA) receptors in monkeys can abolish neural signals related to figure-ground segregation and feature integration. However, it is unknown whether this also affects perceptual integration itself. Therefore, we tested whether ketamine, a non-competitive NMDA receptor antagonist, reduces feature integration in humans. We administered a subanesthetic dose of ketamine to healthy subjects who performed a texture discrimination task in a placebo-controlled double blind within-subject design. We found that ketamine significantly impaired performance on the texture discrimination task compared to the placebo condition, while performance on a control fixation task was much less impaired. This effect is not merely due to task difficulty or a difference in sedation levels. We are the first to show a behavioral effect on feature integration by manipulating the NMDA receptor in humans.
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Affiliation(s)
- Julia D. I. Meuwese
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Cognitive Science Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Anouk M. van Loon
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Cognitive Science Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - H. Steven Scholte
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Cognitive Science Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Philipp B. Lirk
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nienke C. C. Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Victor A. F. Lamme
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Cognitive Science Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
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40
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Persson J. Ketamine in pain management. CNS Neurosci Ther 2013; 19:396-402. [PMID: 23663314 DOI: 10.1111/cns.12111] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 03/14/2013] [Accepted: 03/15/2013] [Indexed: 11/28/2022] Open
Abstract
For ketamine's fiftieth birthday, a narrative review of this unique drug in pain management is presented. Its history is traced from its conception, and its heritage, as a phencyclidine offspring, delineated. The earliest roots of the conceptions concerning the mechanisms of action are sought, and then followed in preclinical as well as clinical research. The major proposed mechanisms in the literature are commented on and evaluated. The growth of the clinical evidence for perioperative pain, acute pain, and chronic pain is followed from early attempts to systematic reviews. Finally, an attempt is made to foresee what the next 50 years might hold in store for our 50 years old.
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Affiliation(s)
- Jan Persson
- Department of Anesthesia and Intensive Care, Pain Clinic, Karolinska University Hospital, Stockholm, Sweden.
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41
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Polomano RC, Buckenmaier CC, Kwon KH, Hanlon AL, Rupprecht C, Goldberg C, Gallagher RM. Effects of low-dose IV ketamine on peripheral and central pain from major limb injuries sustained in combat. PAIN MEDICINE 2013; 14:1088-100. [PMID: 23590428 DOI: 10.1111/pme.12094] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Examine response patterns to low-dose intravenous (IV) ketamine continuous infusions on multiple pain outcomes, and demonstrate effectiveness, safety, and tolerability of ketamine administration on general wards. DESIGN Retrospective case series of consecutive patients given low-dose IV ketamine continuous infusions. SETTING Walter Reed Army Medical Center, Washington, DC. PATIENTS Nineteen eligible inpatients with neuropathic pain from major limb injuries sustained in combat with inadequate pain control from multimodal analgesia. INTERVENTIONS A 3-day IV infusion of ketamine at doses ≤ 120 μg/kg/h. OUTCOME MEASURES Daily present (PPI), average (API), and worst (WPI) pain intensity (0-10), global pain relief (GPR) (1 "no relief" to 5 "complete relief"), daily assessments of adverse events, and daily opioid requirements measured during therapy. RESULTS A significant reduction in PPI (P < 0.001) and improvement in GPR (P = 0.031) was noted over time. Higher baseline WPI (≥ 7; N = 4) was associated with a significant decrease in WPI (P = 0.0388), but lower baseline WPI (N = 5) was not. Significant mean percent decreases in PPI with higher baseline PPI (N = 8; P = 0.0078) and WPI with no phantom limb pain (PLP) (N = 10; P = 0.0436) were observed. Mean percent increase in overall GPR was better for those reporting GPR scores ≤ 3 (N = 13) in the first 24 hours of therapy (P = 0.0153). While not significant, mean opioid requirement (IV morphine equivalents) decreased from 129.9 mgs ± 137.3 on day 1 to 112.14 ± 86.3 24 hours after therapy. CONCLUSIONS Low-dose ketamine infusions for complex combat injury pain were safe and effective, and demonstrated response patterns over time and by baseline pain score stratification and presence or absence of PLP.
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Affiliation(s)
- Rosemary C Polomano
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania 1904, USA.
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Swartjes M, Mooren RAG, Waxman AR, Arout C, van de Wetering K, den Hartigh J, Beijnen JH, Kest B, Dahan A. Morphine induces hyperalgesia without involvement of μ-opioid receptor or morphine-3-glucuronide. Mol Med 2012; 18:1320-6. [PMID: 23001479 DOI: 10.2119/molmed.2012.00244] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 09/11/2012] [Indexed: 11/06/2022] Open
Abstract
Opioid-induced hyperalgesia (OIH) is a paradoxical increase in pain perception that may manifest during opioid treatment. For morphine, the metabolite morphine-3-glucuronide (M3G) is commonly believed to underlie this phenomenon. Here, in three separate studies, we empirically assess the role of M3G in morphine-induced hyperalgesia. In the first study, CD-1 mice injected with morphine (15 mg/kg subcutaneously) after pretreatment with the opioid receptor antagonist naltrexone (NTX) (15 mg/kg) showed tail withdrawal latency reductions indicative of hyperalgesia (2.5 ± 0.1 s at t = 30 min, P < 0.001 versus baseline). In these mice, the morphine/M3G concentration ratios versus effect showed a negative correlation (r(p) = -0.65, P < 0.001), indicating that higher morphine relative to M3G concentrations are associated with increased OIH. In the second study, similar hyperalgesic responses were observed in mice lacking the multidrug resistance protein 3 (MRP3) transporter protein (Mrp3(-/-) mice) in the liver and their wild-type controls (FVB mice; latency reductions: 3.1 ± 0.2 s at t = 30 min, P < 0.001 versus within-strain baseline). In the final study, the pharmacokinetics of morphine and M3G were measured in Mrp3(-/-) and FVB mice. Mrp3(-/-) mice displayed a significantly reduced capacity to export M3G into the systemic circulation, with plasma M3G concentrations just 7% of those observed in FVB controls. The data confirm previous literature that morphine causes hyperalgesia in the absence of opioid receptor activation but also indicate that this hyperalgesia may occur without a significant contribution of hepatic M3G. The relevance of these data to humans has yet to be demonstrated.
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Affiliation(s)
- Maarten Swartjes
- Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
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Höffken O, Haussleiter IS, Westermann A, Lötsch J, Maier C, Tegenthoff M, Schwenkreis P. Influence of (S)-ketamine on human motor cortex excitability. Exp Brain Res 2012. [DOI: 10.1007/s00221-012-3347-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nannarone S, Spadavecchia C. Evaluation of the clinical efficacy of two partial intravenous anesthetic protocols, compared with isoflurane alone, to maintain general anesthesia in horses. Am J Vet Res 2012; 73:959-67. [PMID: 22738046 DOI: 10.2460/ajvr.73.7.959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the ability of 2 partial IV anesthesia (PIVA) techniques to maintain anesthesia, compared with isoflurane alone, in horses. ANIMALS 45 horses. PROCEDURES Client-owned horses requiring general anesthesia for a variety of procedures of at least 1 hour's duration were randomly allocated to 3 groups (n = 15/group) that differed for the maintenance protocol. Anesthesia was maintained with isoflurane with a starting end-tidal isoflurane concentration of 1.3% (isoflurane group) or a concentration of 1% supplemented with an adjustable continuous infusion of guaifenesin-ketamine (IGK group) or romifidine-ketamine (IRK group). A predefined scoring system was used to assess anesthetic depth and to adjust anesthetic delivery. The need for rescue anesthetics and recovery quality were compared. RESULTS A mean ± SD end-tidal isoflurane concentration of 1.36 ± 0.16% was necessary to maintain a surgical plane of anesthesia in the isoflurane group. Mean infusion rates of 5.0 ± 1.3 μL/kg/min and 5.1 ± 0.8 μL/kg/min were necessary to maintain a surgical plane of anesthesia in the IRK and IGK groups, respectively. A lower need for ketamine as a rescue anesthetic was observed in the IGK group, compared with the isoflurane group. Higher blood pressure and lower heart rates were found at selected time points for the IRK group, compared with the IGK and isoflurane groups. CONCLUSIONS AND CLINICAL RELEVANCE Both PIVA protocols were satisfactory to maintain smooth and stable surgical anesthesia in horses. The present study supports previous findings in which PIVA has isoflurane-sparing effects. Furthermore, PIVA did not impair recovery quality.
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Affiliation(s)
- Sara Nannarone
- Department of Pathology, Diagnostic and Veterinary Clinic, Section of Surgery and Radiodiagnostic, Veterinary Teaching Hospital, University of Perugia, 06126, Perugia, Italy.
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Abstract
OBJECTIVE High doses or prolonged exposure to ketamine increase neuronal apoptosis in the developing brain, although effects on neural stem progenitor cells remain unexplored. This study investigated dose- and time-dependent responses to ketamine on cell death and neurogenesis in cultured rat fetal cortical neural stem progenitor cells. DESIGN Laboratory-based study. SETTING University research laboratory. SUBJECT Sprague-Dawley rats. INTERVENTIONS Neural stem progenitor cells were isolated from the cortex of Sprague-Dawley rat fetuses on embryonic day 17. In dose-response experiments, cultured neural stem progenitor cells were exposed to different concentrations of ketamine (0-100 µM) for 24 hrs. In time-course experiments, neural stem progenitor cells cultures were exposed to 10 µM ketamine for different durations (0-48 hrs). MEASUREMENTS AND MAIN RESULTS Apoptosis and necrosis in neural stem progenitor cells were assessed using activated caspase-3 immunostaining and lactate dehydrogenase assays, respectively. Proliferative changes in neural stem progenitor cells were detected using bromo-deoxyuridine incorporation and Ki67 immunostaining. Neuronal differentiation was assessed using Tuj-1 immunostaining. Cultured neural stem progenitor cells were resistant to apoptosis and necrosis following all concentrations and durations of ketamine exposure tested. Ketamine inhibited proliferation with decreased numbers of bromo-deoxyuridine-positive cells following ketamine exposure to 100 µM for 24 hrs (p<.005) or 10 µM for 48 hrs (p< .01), and reduced numbers of Ki67-positive cells following exposure to ketamine concentration>10 µM for 24 hrs (p<.001) or at 10 µM for 48 hrs (p<.01). Ketamine enhanced neuronal differentiation, with all ketamine concentrations increasing Tuj-1-positive neurons (p<.001) after 24-hrs of exposure. This also occurred with all exposures to 10 µM ketamine for >8 hrs (p<.001). CONCLUSIONS Clinically relevant concentrations of ketamine do not induce cell death in neural stem progenitor cells via apoptosis or necrosis. Ketamine alters the proliferation and increases the neuronal differentiation of neural stem progenitor cells isolated from the rat neocortex. These studies imply that ketamine exposure during fetal or neonatal life may alter neurogenesis and subsequent brain development.
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Niesters M, Dahan A. Pharmacokinetic and pharmacodynamic considerations for NMDA receptor antagonists in the treatment of chronic neuropathic pain. Expert Opin Drug Metab Toxicol 2012; 8:1409-17. [DOI: 10.1517/17425255.2012.712686] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Davies DJ, Crowe M, Lucas N, Quinn J, Miller DD, Pritchard S, Grose D, Bettini E, Calcinaghi N, Virginio C, Abberley L, Goldsmith P, Michel AD, Chessell IP, Kew JNC, Miller ND, Gunthorpe MJ. A novel series of benzimidazole NR2B-selective NMDA receptor antagonists. Bioorg Med Chem Lett 2012; 22:2620-3. [PMID: 22366657 DOI: 10.1016/j.bmcl.2012.01.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/25/2012] [Accepted: 01/27/2012] [Indexed: 11/18/2022]
Abstract
A series of novel benzimidazoles are discussed as NR2B-selective N-methyl-d-aspartate (NMDA) receptor antagonists. High throughput screening (HTS) efforts identified a number of potent and selective NR2B antagonists such as 1. Exploration of the substituents around the core of this template identified a number of compounds with high potency for NR2B (pIC(50) >7) and good selectivity against the NR2A subunit (pIC(50) <4.3) as defined by FLIPR-Ca(2+) and radioligand binding studies. These agents offer potential for the development of therapeutics for a range of nervous system disorders including chronic pain, neurodegeneration, migraine and major depression.
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Affiliation(s)
- David J Davies
- GlaxoSmithKline R&D, Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, UK
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Sigtermans M, Noppers I, Sarton E, Bauer M, Mooren R, Olofsen E, Dahan A. An observational study on the effect of S(+)-ketamine on chronic pain versus
experimental acute pain in Complex Regional Pain Syndrome type 1 patients. Eur J Pain 2012; 14:302-7. [DOI: 10.1016/j.ejpain.2009.05.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 05/16/2009] [Accepted: 05/23/2009] [Indexed: 01/17/2023]
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Population pharmacokinetic-pharmacodynamic modeling of ketamine-induced pain relief of chronic pain. Eur J Pain 2012; 15:258-67. [DOI: 10.1016/j.ejpain.2010.06.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 06/02/2010] [Accepted: 06/17/2010] [Indexed: 10/19/2022]
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50
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Absence of long-term analgesic effect from a short-term S-ketamine infusion on fibromyalgia pain: A randomized, prospective, double blind, active placebo-controlled trial. Eur J Pain 2012; 15:942-9. [DOI: 10.1016/j.ejpain.2011.03.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/04/2011] [Accepted: 03/14/2011] [Indexed: 11/24/2022]
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