Prošlost, sadašnjost i budućnost korištenja ketamina u hitnoj medicini

master's thesis

• Title (english): Past, present and future of ketamine use in emergency medicine
• Author: Điđi Delalić
• Mentor: Ingrid Prkačin (mentor)
• Committee member: Jasenka Markeljević (predsjednik povjerenstva)
• Committee member: Marija Bakula (član povjerenstva)
• Committee member: Ingrid Prkačin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Ketamin, najčešće formuliran kao ketamin hidroklorid, je nebarbituratni disocijativni anestetik. Prema kemijskoj strukturi, ketamin je derivat cikloheksanona. Farmakodinamski, ketamin interagira s više različitih vrsta receptora, ali se najznačajnijom smatra interakcija s N-metil-D-aspartatnim (NMDA) receptorima, koja je po prirodi antagonistička. Ketamin također interagira s opioidnim mu receptorima, zbog čega posjeduje analgetska svojstva. Poznate su i interakcije ketamina sa sigma receptorima, za koje se smatra da za posljedicu imaju smanjenje centralne senzitizacije na bol te ublažavanje “wind-up” fenomena (pojave pri kojoj se bolni podražaji serijski uvećavaju s kontinuiranom manipulacijom ozlijeđenog dijela tijela, npr kod opeklina). Navedena svojstva čine ketamin moćnim sredstvom za ublažavanje boli u hitnoj službi. Nadalje, zahvaljujući već spomenutim mnogobrojnim interakcijama s različitim vrstama receptora u ljudskom tijelu, ketamin uz analgetska svojstva posjeduje i moćan sedacijski učinak, djeluje kao bronhidilatator, omogućava očuvanje refleksa dišnog puta pri proceduralnoj sedaciji, ima simpatomimetičko djelovanje te može terminirati status epilepticus refraktoran na konvencionalnu medikamentoznu terapiju. Obzirom na opisana svojstva i djelovanja, ketamin čini neizostavan alat modernog liječnika u hitnoj službi. Literatura vezana uz hitnu medicinu obiluje publikacijama koje dodatno razjašnjavaju upotrebu ketamina za postojeće indikacije ili istražuju nove indikacije za njegovo korištenje te je gotovo sigurno da će ketamin i u budućnosti predstavljati versatilan, pouzdan i dostupan lijek na koji će se liječnici u hitnoj službi oslanjati za zbrinjavanje širokog spektra hitnih stanja.

Abstract (english)

Ketamine, most commonly available as a formulation of ketamine hydrochloride, is a nonbarbiturate dissociative anesthetic agent. Categorized by chemical structure, ketamine is a derivative of cyclohexanone. Pharmacodynamically, ketamine interacts with several different receptor types, however its most significant interaction is the one with the N-methyl-Daspartate (NMDA) receptor, which is an antagonistic interaction. Ketamine is also known to interact with opioid mu receptors, which is why it posesses analgesic properties. Also known are the interaction of ketamine with sigma receptors, which are considered to result in a reduction of central senzitisation to pain, as well as the reduction of “wind-up” phenomenon (a phenomenon in which painful stimuli are serially amplified with continuous manipulation of the injured body part, for example in burn patients). The described properties make ketamine a potent analgesic in the emergency department. Furthermore, owing to the already mentioned numerous interactions with multiple receptor types, ketamine is also a potent sedation agent, a bronchodilator, enables maintenance of airway reflexes during procedural sedation, is a sympathomimetic and can terminate status epilepticus refractory to conventional medical therapy. Due to the described effects and properties, ketamine is an essential tool of the modern emergency physician. Emergency medicine literature is rife with publications that further clarify the usage of ketamine for existing indications or investigate new indications for its use and it is almost certain that ketamine will remain a versatile, reliable and easily available medication that emergency physicians will rely on for the management of a wide spectrum of emergencies.

• Keywords: Analgezija; Hitna Medicina; Ketamin
• Keywords (english): Analgesia; Emergency Medicine; Ketamine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:044062
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-10-24 08:58:34