3. GOODCHILD - intranasal ketamine ANZCA FPM spring 2009.pdf
3. GOODCHILD - intranasal ketamine ANZCA FPM spring 2009.pdf
3. GOODCHILD - intranasal ketamine ANZCA FPM spring 2009.pdf
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Professor Colin S Goodchild<br />
Monash Institute of Medical research
fi fast onset<br />
› gain access to circulation in sufficient quantities<br />
fi reasonably fast offset<br />
fi low side effect profile<br />
fi predictable<br />
fi safe
• study performed in adults<br />
• 25 mg racemic <strong>ketamine</strong> <strong>intranasal</strong>ly<br />
• samples @ 5, 10, 20, 30 minutes post dose – 20 ng/ml at 5 mins<br />
• 45% bio-availability
• 50 mg dose<br />
• pain score same @ 10 min cf 20-<br />
60<br />
• 50% side effects<br />
•a ceiling effect<br />
• 20-30 mg probably sufficient<br />
v lower side effect profile<br />
• shorter duration<br />
collection time 2 min 30 min 60 min<br />
<strong>ketamine</strong> (ng/ml) 22.4 ± 16.8 49.8 ± 29.8 39.9 ± 20.6<br />
nor-<strong>ketamine</strong> (ng/ml) 0.06 ± 0.22 45.5 ± 34.1 66.1 ± 30.6
fi BL - 23 yr old female<br />
fi gastroenteritis<br />
› immunocompromised<br />
› fungal abscesses<br />
› chest (oesophageal perforation, broncho-pleural fistula)<br />
› intracranial fungal abscess<br />
fi ICU 8 months<br />
› morphine/midazolam/propofol<br />
› all over hyperalgesia<br />
› 15 cm pre sacral sore down to bone
fi opioid must be present<br />
fi extra opioid with the <strong>ketamine</strong> is an option<br />
› sufentanil/fentanyl<br />
fi GO Medical PCINA device (no lockout)<br />
› 0.2 ml dose = 10 mg<br />
fi two puffs, one to each nostril<br />
› can be increased
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