p.2
NMDA Receptor Antagonism
What type of receptor does ketamine act on as a non-competitive antagonist?
NMDA receptor at phencyclidine site
What type of activity does ketamine have on sodium and calcium channels?
Local Anesthetic (LA) activity (NA channel blockade, L type CCB)
What is the effect of ketamine on blood glucose and cortisol levels?
Ketamine increases blood glucose and cortisol levels.
How does ketamine affect plasma cholinesterase?
Ketamine inhibits plasma cholinesterase.
How does ketamine affect uterine muscle tone?
Ketamine increases uterine muscle tone.
What effect does ketamine have on myocardial oxygen consumption?
Ketamine increases myocardial oxygen consumption and blocks ischemic preconditioning.
p.2
Tolerance and Metabolism of Ketamine
What is the primary route of ketamine metabolism?
Hepatic metabolism by cP450
p.2
Comparison with Other Anesthetics
What is the effect of ketamine on systemic vascular resistance (SVR) and blood pressure (BP)?
↑SVR 30%; ↑BP 40%; ↑PVR 30%; ↑PAP 45%; ↑HR 50%; ↑CO, ↑O2 consumption
p.2
Comparison with Other Anesthetics
What is the effect of ketamine on bronchial activity?
Bronchodilation ((↑NE, anti-M, CCB effect), salivary and transbronchial mucus gland secretion)
p.3
Tolerance and Metabolism of Ketamine
What is the relationship between enzyme induction and ketamine tolerance?
Enzyme induction leads to accelerated metabolism, contributing to ketamine tolerance.
p.2
Comparison with Other Anesthetics
What is the effect of ketamine on spontaneous ventilation and CO2 response?
Maintains spontaneous ventilation and CO2 response (transient ↓TV ↑RR / apnea ONLY if given rapidly or opioid included in pre-med)
p.2
Comparison with Other Anesthetics
What is a contraindication for ketamine use related to cardiovascular conditions?
Systemic and pulmonary hypertension, increase ICP, eye procedure, porphyria
p.2
Comparison with Other Anesthetics
What is the effect of ketamine on pharyngeal and laryngeal reflexes?
Pharyngeal and laryngeal reflex maintained
p.2
Effects on EEG and Consciousness
What type of anesthesia does ketamine induce?
Dissociative anesthesia (functional and electrical dissociation between thalamocortical and limbic system)
What are the effects of ketamine on muscle tone and movement?
Ketamine increases muscle tone and causes jerking movements of limbs.
p.2
Mechanism of Action in Depression
What is the effect of ketamine on the descending monoaminergic pathway?
Modulates descending monoaminergic (NE, D, 5HT) pathway
p.2
Comparison with Other Anesthetics
What is the effect of ketamine on the sympathetic nervous system (SNS)?
SNS stimulating effect (↑NE at NTS, peripheral inhibit uptake)
p.2
Comparison with Other Anesthetics
What is the effect of ketamine on myocardial function?
Direct myocardial depressant
p.2
Comparison with Other Anesthetics
What is the effect of ketamine on regional blood flow?
Regional blood flow due to vasoconstriction
p.2
Emergence Delirium and Side Effects
What are some symptoms of emergence delirium caused by ketamine?
Visual, auditory, proprioceptive, confusion, delirium
What is the effect of ketamine on the production of inflammatory cytokines?
Inhibits production of inflammatory cytokines
p.2
Analgesic Properties of Ketamine
What type of pain does ketamine provide analgesia for?
Somatic and visceral pain (pre-emptive analgesia)
p.2
Effects on EEG and Consciousness
What is the effect of ketamine on the thalamic and limbic systems?
EEG dissociation between thalamocortical and limbic system
p.2
Effects on EEG and Consciousness
What is the effect of ketamine on EEG patterns?
EEG: abolition of alpha rhythm and dominance of theta activity, onset of delta coincides with loss of consciousness, HD - burst suppression pattern
