Effects of peritraumatic ketamine medication on early and sustained posttraumatic stress symptoms in moderately injured accident victims

Schönenberg, Michael; Reichwald, Ursula; Domes, Gregor; Badke, Andreas; Hautzinger, Martin

doi:10.1007/s00213-005-0094-4

Cited by 67 publications

(46 citation statements)

References 30 publications

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“…Preclinical research is equivocal, with evidence showing that ketamine has anxiolytic effects but another study showing that administration of ketamine after a stressor does not prevent behavioral disruption (Juven-Wetzler et al, 2014;Zhang et al, 2014). A retrospective study of 56 injured accident victims found PTSD symptoms approximately 1 year post-accident were higher in those who had received (S)-ketamine during ambulance transportation, but were equal in those receiving racemic ketamine or opioids (Schönenberg et al, 2005). A chart review of 147 military service members who underwent surgery after a burn found that prevalence of subsequent PTSD was lower among those who had received intraoperative ketamine than those who had not (McGhee et al, 2008).…”

Section: Somatic Approachesmentioning

confidence: 99%

Prevention of Trauma and Stressor-Related Disorders: A Review

Howlett

Stein

2015

Neuropsychopharmacol

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Posttraumatic stress disorder (PTSD) is a common, frequently chronic, and disabling condition which, along with acute stress disorder (ASD), is categorized as a trauma-and stressor-related disorder by the DSM-5. These disorders are unique in requiring exposure to a severe stressor, which implies that potential sufferers could be identified and helped before developing a disorder. Research on prevention strategies for stress-related disorders has taken a number of avenues, including intervention before and after trauma and the use of both psychosocial and somatic approaches. Despite advances in neurobiological understanding of response to trauma, clinical evidence for preventive interventions remains sparse. This review provides an overview of prevention approaches and summarizes the existing literature on prevention of ASD and PTSD, including clinical and preclinical studies. Given the potential benefits to trauma survivors and society, the development of effective preventive interventions should be given greater priority. Resources should be directed to adequately test promising interventions in clinical trials, and research should be conducted according to translational research principles in which preclinical research informs the design of clinical studies.

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Section: Somatic Approachesmentioning

confidence: 99%

Prevention of Trauma and Stressor-Related Disorders: A Review

Howlett

Stein

2015

Neuropsychopharmacol

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“…Given that retrospection as well as subsequent symptomatology might have biased participants' self-reports on acute stress symptoms in our previous study (Schönenberg et al, 2005), the purpose of the present study was to re-examine whether ketamine administration after moderate accidental trauma augments dissociation and other symptoms of ASD in the direct aftermath of the event. Additionally, it remains unclear whether opioid medication might have successfully prevented post-traumatic maladaptation, probably by affecting fear conditioning and consolidation of traumatic memories (Saxe et al, 2001).…”

Section: Introductionmentioning

confidence: 98%

Ketamine aggravates symptoms of acute stress disorder in a naturalistic sample of accident victims

et al. 2008

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The glutamatergic N-methyl-D-aspartate receptor antagonist ketamine produces transient dissociative states and alters cognitive functioning in healthy humans, thus resembling the core symptoms of acute and chronic post-traumatic stress disorder (PTSD). First evidence exists that the common use of the analgesic and sedative properties of ketamine during emergency care correlates with sustained symptoms of PTSD in accident victims. The aim of the present study was to examine whether ketamine administration after moderate accidental trauma modulates dissociation and other symptoms of acute stress disorder (ASD) in the direct aftermath of the event. Accident victims were screened within the third day after admission to hospital for symptoms of ASD (Peritraumatic Dissociative Experiences Questionnaire, ASD Scale) and prior stressful life events (Traumatic Life Events Questionnaire). Subjects had received a single or fractionated dose of either racemic ketamine (n=13), opioids (n=24) or non-opioid analgesics (n=13) during initial emergency treatment. There were no significant differences between medication groups in demographic and clinical characteristics such as injury severity or prior traumatization. With respect to ASD symptomatology three days post-event there were significant associations between ketamine analgosedation and increased symptoms of dissociation, reexperiencing, hyperarousal and avoidance relative to the comparison groups.Growing evidence exists that ketamine might modulate or aggravate early post-traumatic stress reactions when given in the acute trauma phase, which in turn might contribute to long-lasting symptomatology.

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“…isomer of ketamine to an increased risk of acute stress disorder and post-traumatic stress disorder (PTSD) when compared to opioids [22]. The use of racemic ketamine (available in the United States) has been associated with an increased incidence of acute stress disorder including re-experiencing and hyper arousal, but has not been shown to contribute to PTSD [22,23]. Consequently, data regarding the ketamine-PTSD relationship are inconsistent.…”

Section: Ketaminementioning

confidence: 99%

Choice of General Anesthetics for Trauma Patients

Sikorski

Koerner

Fouché-Weber

et al. 2014

Curr Anesthesiol Rep

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The trauma anesthesiologist has multiple competing concerns when supporting the patient with major trauma, but the priority must be focused on adequate resuscitation to facilitate surgical hemostasis. A broad, evidence-informed knowledge of airway management, resuscitation, physiology, pharmacology, and critical care is required to address the unique pathophysiological processes encountered in trauma. Judicious selection of anesthetic agents is crucial to ensure optimal outcomes. In this review, we describe approaches for the induction and maintenance of general anesthesia for the patient with major trauma. Considerations for ongoing resuscitation and hemodynamic instability will be explored and discussed with respect to the administration of anesthetic induction and maintenance agents. Practices at our institution are reviewed, including the administration of high-dose opioids as an integral part of both resuscitation and anesthesia for the patient with major trauma.

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Effects of peritraumatic ketamine medication on early and sustained posttraumatic stress symptoms in moderately injured accident victims

Abstract: The data provide first evidence for a modulating effect of a single-dose ketamine on the severity and duration of posttraumatic stress symptoms in accident victims.

Cited by 67 publications

References 30 publications

Prevention of Trauma and Stressor-Related Disorders: A Review

Prevention of Trauma and Stressor-Related Disorders: A Review

Ketamine aggravates symptoms of acute stress disorder in a naturalistic sample of accident victims

Choice of General Anesthetics for Trauma Patients

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