Ketamine and morphine

Synthetic opioids compared with morphine and ketamine catalepsy, cross-tolerance and interactions in the rat Benthuysen, J. L. Hance, A. J. Quam, D. D. Winters, W. D. Neuropharmacology (1989), 28(10), 1011-15... 

Drug-drug interactions A randomised controlled trial (n = 135) showed significant synergism in pain control between morphine and ketamine in a prehospital setting [58 ]. 

Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, et al. Morphine and ketamine is superior to morphine alone for out-of-hospital trauma analgesia a randomized controlled trial. Ann Emerg Med June 2012 59(6) 497-503. 

Eide, P. K., Jorum, E., Stubhaug, A., Bremmes, J., Breivik, H. Relief of post-herpetic neuralgia with the N-methyl-D-aspartic acid receptor antagonist ketamine a double-blind, cross-over comparison with morphine and placebo, Pain 1994, 58, 347-354. 

Alcohol is just one of many drugs used to facilitate rape. Others include marijuana, cocaine, benzodiazepines, barbiturates, chloral hydrate, methaqualone ( quaaludes ), heroin, morphine, and LSD. Three of the more commonly used drugs today—and the ones that are the focus of this book—are Rohypnol, gamma hydroxybutyrate ( GHB ), and ketamine. Though Rohypnol and GHB were initially used as recreational drugs at clubs and raves, word soon spread among American youth that these drugs could be used quite effectively to commit rape. 

When added to standard doses of morphine and a non- steroidal analgesic, 5-ketamine 0.5 mg/kg had no additional benefit in a randomized, double-blind study in 30 patients undergoing anterior cruciate ligament repair (9). 

This neurotoxicity could have been due to the preservative benzethonium chloride or the ketamine. However, several other agents, including bupivacaine, morphine, and clonidine, were also given intrathecally, so causality was not proven, even though the other agents have not been associated with this problem. 

The effects of a combination of morphine and a subanesthetic dose of ketamine have been studied in 41 patients undergoing thoracotomy in a double-blind, randomized study [131. The addition of ketamine reduced morphine consumption by 45%, achieved equivalent pain management, and was associated with fewer adverse events. 

Lin Y-H, Li J-H, Ko W-K, Wu S-M (2006) Direct and sensitive analysis of methamphet-amine, ketamine, morphine and codeine in human urine by cation-selective exhaustive injection and sweeping micellar electrokinetic chromatography. J Chromatogr A 1130(2) 281-286... 

The addition of ketamine as an opiate sparer, 1.5 or 5 mg per bolus morphine dose, has been studied in 58 patients undergoing transthoracic heart and lung surgery, a procedure that is associated with severe pain [122 ]. Those who took ketamine used 50% less morphine and required less rescue diclofenac for pain control. Pain scores were consistently lower with ketamine, despite reduced amounts of morphine administered. Respiratory parameters were much better with ketamine none compared with seven patients requiring oxygen for hypoxia. The... 

In 82 children undergoing tonsillectomy who were randomized to morphine 0.1 mg/kg alone or in combination with ketamine 0.25 mg/kg after sevoflurane induction, there were no differences in the duration of anesthesia, surgery, or recovery between the two groups [25 ]. There were no differences in pain scores or total morphine consumption, but the ketamine group required less rescue morphine during recovery. There were no episodes of hallucinations after ketamine. However, the incidence of vomiting was 7.5% with morphine and 2.3% with ketamine. 

Fig. 1. Chromatogram of quantitation transitions from positive patient sampie. Positive for morphine, hydromorphone, ketamine, oxazepam, temazepam, and THC-COOH.

All the drugs tested in these experiments were administered (IP) at doses ranging from 3 to 10 mg/kg (except for ketamine, which was tested at 10, 30, and 100 mg/kg). All the rats used had previously turned contralaterally in response to 0.05 mg/kg apo-morphine HC1. Net ipsilateral rotations were counted in two consecutive 15-minute bins, immediately following drug (or saline) admi ni strati on. ... 

Preanesthetic medications such as morphine, scopolamine, benzodiazepine, and buty-rophenones lower dysphoric effects of ketamine. Synonyms for this drug are ketanest, ketalar, and others. 

Plesan, A., Hedman, U., Xu, X.-J., Wiesenfeld-Hallin, Z. Comparison of ketamine and dextromethorphan in potentiating the antinociceptive effect of morphine in rats, Anesth. Analg. 1998, 86, 825-829. 

Several drugs are used intravenously, alone or in combination with other drugs, to achieve an anesthetic state (as components of balanced anesthesia) or to sedate patients in intensive care units who must be mechanically ventilated. These drugs include the following (1) barbiturates (thiopental, methohexital) (2) benzodiazepines (midazolam, diazepam) (3) opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil) (4) propofol (5) ketamine and (6) miscellaneous drugs (droperidol, etomidate, dexmedetomidine). Figure 25-2 shows the structures of... 

There was a higher incidence of adverse effects of morphine in patients with renal insufficiency who receive opioids for some time (37), and in patients with hemolytic uremic syndrome who were given ketamine with subcutaneous morphine postoperatively (38). 

Bristow A, Orlikowski C. Subcutaneous ketamine analgesia postoperative analgesia using subcutaneous infusions of ketamine and morphine. Ann R Coll Surg Engl 1989 71(l) 64-6. 

Lauretti GR, Lima IC, Reis MP, Prado WA, Pereira NL. Oral ketamine and transdermal nitroglycerin as analgesic adjuvants to oral morphine therapy for cancer pain management. Anesthesiology 1999 90(6) 1528-33. 

Doherty T J, Geiser D R, Rohrbach B W 1997c Effect of high volume epidural morphine, ketamine and butorphanol on halothane minimum alveolar concentration in ponies. Equine Veterinary Journal 29 370-373... 

Jones D 1993 Clinical effects of detomidine with or without atropine used for arthrocentesis In horses. Canadian Veterinary Journal 34 296-300 Joo G, Horvath G, Klimscha W et al 2000 The effects of ketamine and its enantiomers on the morphine- or dexmedetomidine-induced antinociception after intrathecal administration in rats. Anesthesiology 93 231-241... 

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