Oral Ketamine for the Management of Combative Autistic Adult

Bachenberg, Kenneth L.

doi:10.1097/00000542-199808000-00052

Cited by 12 publications

(13 citation statements)

References 3 publications

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“…Palatability is a crucial factor in children and developmentally delayed patients in whom the acceptability of a medication and, hence, its ease of administration may be greatly affected by the taste and appearance of the drug [3,12]. We want to emphasize in this case report the unique taste of Dr Pepper, which is well suited to mask the bitter taste of midazolam and ketamine.…”

Section: Discussionmentioning

confidence: 94%

“…Some of the methods described include the use of physical restraints, forcible intramuscular injections, and oral medications using sedatives and anxiolytics [3].…”

Section: Discussionmentioning

confidence: 99%

“…The use of oral benzodiazepines, barbiturates, and butyrophenones alone is not always successful in achieving sedation and the cooperation of patients with severe behavioral problems [3]. In contrast, oral ketamine has been safely and effectively used as a premedication for operative procedures both in children and adults [3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…The patient in this case report refused or spat out the oral premedication drugs, possibly because the beverage used did not successfully hide the taste of the premedicant drugs. A correspondence (letter to the editor) piece by Bachenberg [3] mentioned use of oral ketamine as premedication in an autistic combative patient.…”

Section: Discussionmentioning

confidence: 99%

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Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

Shah

Apuya

et al. 2009

J Anesth

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Patients with impaired ability to understand and communicate can be difficult to manage perioperatively. They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. We present a case of a severely autistic and violent patient scheduled for dental rehabilitation under general anesthesia. A combination of oral ketamine and midazolam was mixed in the beverage Dr Pepper to mask the taste and the appearance of the drugs. The unique flavor of Dr Pepper is well suited to increase the palatibility and the acceptability of medications in children and patients with developmental delay.

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Section: Discussionmentioning

confidence: 94%

“…Some of the methods described include the use of physical restraints, forcible intramuscular injections, and oral medications using sedatives and anxiolytics [3].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

Shah

Apuya

et al. 2009

J Anesth

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“…The high translational relevance of our results points to low-dose NMDAR antagonists (or selective NR2A and NR2B blockers) as valuable therapeutic options for reactive aggression. Accordingly, recent studies have highlighted the potential of low-dose or low-potency NMDA antagonists as efficacious anti-aggressive treatments in several neuropsychiatric disorders (Bachenberg, 1998; Wilcock et al, 2008; Ballard et al, 2009). …”

Section: Discussionmentioning

confidence: 99%

NMDARs Mediate the Role of Monoamine Oxidase A in Pathological Aggression

Bortolato¹,

Godar²,

Melis³

et al. 2012

Journal of Neuroscience

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Converging evidence shows that monoamine oxidase A (MAO A), the key enzyme catalyzing serotonin (5-hydroxytryptamine; 5-HT) and norepinephrine (NE) degradation, is a primary factor in the pathophysiology of antisocial and aggressive behavior. Accordingly, male MAO A-deficient humans and mice exhibit an extreme predisposition to aggressive outbursts in response to stress. As NMDARs regulate the emotional reactivity to social and environmental stimuli, we hypothesized their involvement in the modulation of aggression mediated by MAO A. In comparison with WT male mice, MAO A KO counterparts exhibited increases in 5-HT and NE levels across all brain regions, but no difference in glutamate concentrations and NMDAR binding. Notably, the prefrontal cortex (PFC) of MAO A KO mice exhibited higher expression of NR2A and NR2B, as well as lower levels of glycosylated NR1 subunits. In line with these changes, the current amplitude and decay time of NMDARs in PFC was significantly reduced. Furthermore, the currents of these receptors were hypersensitive to the action of the antagonists of the NMDAR complex (dizocilpine), as well as NR2A (PEAQX) and NR2B (Ro 25–6981) subunits. Notably, systemic administration of these agents selectively countered the enhanced aggression in MAO A KO mice, at doses that did not inherently affect motor activity. Our findings suggest that the role of MAO A in pathological aggression may be mediated by changes in NMDAR subunit composition in the PFC, and point to a critical function of this receptor in the molecular bases of antisocial personality.

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Decades of Progress in the Psychopharmacology of Autism Spectrum Disorder

Henneberry

Lamy

Dominick

et al. 2021

J Autism Dev Disord

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Recent decades have been marked by a wave drug treatment research in autism spectrum disorder (ASD). This work has resulted in improved ability to treat commonly occurring behavioral challenges associated with ASD including most prominently irritability marked by aggression, self-injurious behavior, and severe tantrums. While treatment of interfering behavior has progressed in our field, there remain several areas of unmet medical need including most prominently a lack of any approved drug therapies for the core, defining symptoms of autism. We outline the progress to date in the field of autism drug treatment while taking a future look forward into how decades of work can inform better future steps in this field.

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Oral Ketamine for the Management of Combative Autistic Adult

Cited by 12 publications

References 3 publications

Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

Combination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient

NMDARs Mediate the Role of Monoamine Oxidase A in Pathological Aggression

Decades of Progress in the Psychopharmacology of Autism Spectrum Disorder

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