Anaesthesia – mechanisms and current practice
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The document discusses ketamine, its mechanisms of action, current uses, and emerging concepts. Ketamine is a dissociative anesthetic that blocks NMDA receptors and has effects on multiple other receptors and pathways involved in neuronal plasticity, synaptogenesis, and protein synthesis. It maintains hemodynamic stability and airway reflexes better than other anesthetics. Emerging research suggests ketamine may have long-term antidepressant effects through induction of neuroplasticity.
Anaesthesia – mechanisms and current practice
- 1. | 1 Jonas Åkeson, MD, PhD, EDAIC, ETP Professor/Sr Consultant Anaesthesiology and Intensive Care Medicine Lund University Skåne University Hospital Malmö Sweden KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se Anaesthesia – mechanisms and current practice
- 2. | 2 Jonas Åkeson, MD, PhD, EDAIC, ETP Professor/Sr Consultant Anaesthesiology and Intensive Care Medicine Lund University Skåne University Hospital Malmö Sweden KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se No conflict of interest
- 3. | 3 KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se phencyclidine
- 4. | 4 KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se phencyclidine
- 5. | 5 KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 6. | 6 KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se S-(+)-ketamine R-(–)-ketamine
- 7. | 7 KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se racemic ketamine
- 8. | 8 KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se racemic ketamine
- 9. | 9 Induces a dissociative state of anaesthesia KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 10. | 10 Induces long-term neuronal plasticity within the brain KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 11. | 11 May promote long-term neurotransmission by interfering with protein synthesis and postsynaptic neuronal membrane receptor density KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 12. | 12 . NMDA- receptor Glu ketamin . ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 13. | 13 . NMDA- receptor Glu ketamin AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 14. | 14 . NMDA- receptor Glu calcium- channel ketamin AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 15. | 15 . NMDA- receptor Glu calcium- channel ketamin AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 16. | 16 . NMDA- receptor Glu calcium- channel ketamin BDNF AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 17. | 17 . NMDA- receptor Glu Ca calcium- channel tropo- myosine- receptor- kinase B BDNF AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 18. | 18 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosine- receptor- kinase B BDNF mitogen-activated protein kinase AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 19. | 19 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosine- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 20. | 20 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosine- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin
- 21. | 21 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin glycogen-synthetase- kinase-3
- 22. | 22 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor lithium ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin glycogen-synthetase- kinase-3
- 23. | 23 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin glycogen-synthetase- kinase-3 lithium
- 24. | 24 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin glycogen-synthetase- kinase-3
- 25. | 25 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se glycogen-synthetase- kinase-3 p70-ribosomal protein-S6-kinase mammalian target of rapamycin
- 26. | 26 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se glycogen-synthetase- kinase-3 protein translation p70-ribosomal protein-S6-kinase mammalian target of rapamycin
- 27. | 27 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin glycogen-synthetase- kinase-3 protein translation p70-ribosomal protein-S6-kinase synaptogenesis
- 28. | 28 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin glycogen-synthetase- kinase-3 protein translation p70-ribosomal protein-S6-kinase synaptogenesis
- 29. | 29 May promote long-term neurotransmission by interfering with protein synthesis and postsynaptic neuronal membrane receptor density KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 30. | 30 Maintains systemic haemodynamic stability better than other hypnotics KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 31. | 31 Maintains systemic haemodynamic stability better than other hypnotics by also reducing sympathetic reuptake of noradrenaline KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 32. | 32 Does not raise intracranial pressure provided that hypoventilation is avoided KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 33. | 33 Maintains protective airway reflexes, and also skeletal muscle tone, more than other hypnotic anaesthetic drugs KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 34. | 34 Psychotomimetic adverse effects during and after emergence from anaesthesia are lower with S-ketamine and also with initial low-dose midazolam KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 35. | 35 . NMDA- receptor Glu calcium- channel ketamin phosphoinositide- 3-kinase tropo- myosin- receptor- kinase B BDNF mitogen-activated protein kinase extracellular signal-regulated kinase protein- kinase B AMPA- receptor ketamine KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se mammalian target of rapamycin glycogen-synthetase- kinase-3 protein translation p70-ribosomal protein-S6-kinase synaptogenesis
- 36. | 36 May promote long-term neurotransmission by interfering with protein synthesis and postsynaptic neuronal membrane receptor density KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se
- 37. | 37 KETAMINE – CURRENT PRACTICE AND EMERGING CONCEPTS jonas.akeson@med.lu.se