Page 357 - WSAVA2017
P. 357

WSVA7-0555
GLOBAL PAIN COUNCIL
CLINICAL ADVANTAGES OF KETAMINE AND NMDA ANTAGONIST DRUGS
B.D. Wright1
1Veterinary Anesthesiologist — Integrative Pain Management Specialist, Mistralvet.com
Regulatory Update: Human abuse potential has created strong international pressure (China) to increase regulatory control. The commission on narcotic drugs elected NOT to upgrade the regulation of ketamine
to schedule 1 in 2015, but there is still international debate. For more information see the fact sheet that was endorsed by a large number of human and veterinary organizations (in which the WSAVA played an extremely active role) regarding this issue: https://www.asahq. org/~/media/sites/gho/ketamine-fact-sheet-2015
Usage update: Ketamine has uses that bridge: anesthetic (inexpensive and widely available in first through third- world countries), amnesiac, cardiovascular sparing in intensive care, cerebro-protective, anti-glial activation, neuropathic pain and depression suppressing.
The Global Pain Council of the WSAVA utilizes ketamine extensively in the recommendations for countries where opioid analgesics, and safe non-steroidal analgesics are limited.
www.wsava.org/guidelines/global-pain-council-guidelines
Recent human papers evaluating safety in:
1) Intensive care and cerebral perfusion in the ICU (not increasing ICP)
2) Reduced neurotoxicity and improved perfusion in neuro-anesthesia
3) Improved hemodynamics for sedations in ICU
4) Modification of neuropathic pain and anxiety disorders
Veterinary uses: Two primary considerations: Anesthesia and sedation:
Acute Analgesia: NMDA antagonism reduces requirement for opioids, reduced post-operative pain, reduced wind-up at the level of the spinal cord and glia.
The Global Pain Council of the WSAVA utilizes ketamine extensively in the recommendations for countries where opioid analgesics, and safe non-steroidal analgesics are limited.
www.wsava.org/guidelines/global-pain-council-guidelines
Chronic Analgesia: NMDA antagonism mitigates glial hyper-activity and neuropathic pain
1) Spinal cord injury, brain injury peripheral nerve injury 2) Chronic OA
Low cost and high margin of safety at sub-anesthetic doses
Systemic and peripheral applications
Other NMDA antagonists:
1) Amantadine 2-5 mg/kg q 12-24 hours
2) Memantine 0.3-0.5 mg/kg q 12-24 hours
An Urban Experience
  357
                   






































































   355   356   357   358   359