Dissociative Anaesthetics

DissociativeDissociative
AnaestheticsAnaesthetics
Jerry D. Smith Jr.Jerry D. Smith Jr.
14 June 200514 June 2005

Dissociative AnaestheticsDissociative Anaesthetics
“…“…distort perceptions of sight and sound anddistort perceptions of sight and sound and
produce feelings of detachment—dissociation—produce feelings of detachment—dissociation—
from the environment and self.”from the environment and self.”
- US Dept. of Health and Human Services- US Dept. of Health and Human Services

How They Work:How They Work:
• Alter distribution of glutamate throughout theAlter distribution of glutamate throughout the
brainbrain
• Glutamate is involved in perception of pain,Glutamate is involved in perception of pain,
responses to the environment, and memoryresponses to the environment, and memory

Who They AreWho They Are
Prescription Drugs:Prescription Drugs:
KetamineKetamine
TiletamineTiletamine
AmantadineAmantadine

KetamineKetamine
AKA:AKA: Ketamil (vet medicine), Ketalar, Amidate, Brevital, Diprivan, E-thrane,Ketamil (vet medicine), Ketalar, Amidate, Brevital, Diprivan, E-thrane,
Fluothane, Forane, Penthrane, PentothalFluothane, Forane, Penthrane, Pentothal
Forms:Forms: liquidliquid
Use:Use: veterinary and human anaestheticveterinary and human anaesthetic
FYI:FYI: agent of choice in paediatrics, shock patients, asthmatics, and burnagent of choice in paediatrics, shock patients, asthmatics, and burn
patients because depressed respiration is uncommon; effective inpatients because depressed respiration is uncommon; effective in
treating Postherpetic Neuralgia (Douglas, Johnson, & Cunningham,treating Postherpetic Neuralgia (Douglas, Johnson, & Cunningham,
2004; Brown, Lovato, & Parker, 2005)2004; Brown, Lovato, & Parker, 2005)

TiletamineTiletamine
AKA:AKA: Zoletic, TelazolZoletic, Telazol
Forms:Forms: tablet, liquidtablet, liquid
Use:Use: veterinary anaestheticveterinary anaesthetic
FYI:FYI: similar to ketamine and phencyclidine in chemical structure and actionsimilar to ketamine and phencyclidine in chemical structure and action
(Rench-Mullen, Lehmann, Bohacek, & Fisher, 1987)(Rench-Mullen, Lehmann, Bohacek, & Fisher, 1987)

AmantadineAmantadine
AKA:AKA: SymmetrelSymmetrel
Forms:Forms: capsule, tablet, syrupcapsule, tablet, syrup
Use:Use: Antidyskinetic, Antifatigue (specifically in multiple sclerosis), Antiviral;Antidyskinetic, Antifatigue (specifically in multiple sclerosis), Antiviral;
used to treat Parkinson's disease, influenza, Hepatitis C, aspiration inused to treat Parkinson's disease, influenza, Hepatitis C, aspiration in
the elderly; used to temporarily limit or reverse weight gain associatedthe elderly; used to temporarily limit or reverse weight gain associated
with olanzapine (Zyprexa) treatment in patients with schizophrenia,with olanzapine (Zyprexa) treatment in patients with schizophrenia,
schizoaffective disorder, schizophreniform disorder, or bipolar Ischizoaffective disorder, schizophreniform disorder, or bipolar I
disorder (Masi, 2004; “Amantadine for weigh”, 2005; “Alternatives todisorder (Masi, 2004; “Amantadine for weigh”, 2005; “Alternatives to
the flu”, 2004; Smith, Riley III, Devenyi, Bingaman, Kunelman, 2004;the flu”, 2004; Smith, Riley III, Devenyi, Bingaman, Kunelman, 2004;
Kikawada, Iwamoto, Tarasaki, 2005)Kikawada, Iwamoto, Tarasaki, 2005)
FYI:FYI: ongoing research indicates may be effective in treatment of cocaineongoing research indicates may be effective in treatment of cocaine
users with high withdrawal severity (Sofuoglu & Kosten, 2005)users with high withdrawal severity (Sofuoglu & Kosten, 2005)

Street Drugs:Street Drugs:
PhencyclidinePhencyclidine
KetamineKetamine
DextromethorphanDextromethorphan

PhencyclidinePhencyclidine
AKA:AKA: PCP, Angel Dust, Embalming Fluid, PeaCe Pill, Boat, Dummy Dust,PCP, Angel Dust, Embalming Fluid, PeaCe Pill, Boat, Dummy Dust,
Love Boat, Supergrass, Killer Weed, Ozone, Rocket Fuel, Wack, etc.Love Boat, Supergrass, Killer Weed, Ozone, Rocket Fuel, Wack, etc.
Forms:Forms: powder, liquid, tablet, or on smoking materialpowder, liquid, tablet, or on smoking material
Effect:Effect: Numbness, slurred speech, loss of coordination, rapid andNumbness, slurred speech, loss of coordination, rapid and
involuntary eye movements, auditory hallucinations, image distortion,involuntary eye movements, auditory hallucinations, image distortion,
severe mood disorders, amnesia, in some users PCP use may result insevere mood disorders, amnesia, in some users PCP use may result in
acute anxiety, a feeling of impending doom, paranoia, violentacute anxiety, a feeling of impending doom, paranoia, violent
hostility, and in some it may produce a psychoses indistinguishablehostility, and in some it may produce a psychoses indistinguishable
from schizophrenia (“Phencyclidine,” 2001)from schizophrenia (“Phencyclidine,” 2001)
Treatment:Treatment: Symptoms are treated with anti-psychotics, particularly HaloperidolSymptoms are treated with anti-psychotics, particularly Haloperidol
(Haldol)(Haldol)
FYI:FYI: Originally designed as a human anaesthetic and later produced only asOriginally designed as a human anaesthetic and later produced only as
a veterinary anaesthetic, PCP is no longer produced or used fora veterinary anaesthetic, PCP is no longer produced or used for
legitimate purposes because of postoperative psychoseslegitimate purposes because of postoperative psychoses
(“Phencyclidine,” 2001)(“Phencyclidine,” 2001)

KetamineKetamine
AKA:AKA: K, Special-K, Vitamin-K, Jet, Super Acid, Green, Cat ValiumK, Special-K, Vitamin-K, Jet, Super Acid, Green, Cat Valium
Forms:Forms: liquid, powderliquid, powder
Effect:Effect: At lower doses it has a mild, dreamy feeling; users reportAt lower doses it has a mild, dreamy feeling; users report
feeling floaty and slightly outside their body; numbness in thefeeling floaty and slightly outside their body; numbness in the
extremities is also common; higher doses produce an effectextremities is also common; higher doses produce an effect
referred to as "K-Hole," an "out of body," or "near-death"referred to as "K-Hole," an "out of body," or "near-death"
experience; use of the drug can cause delirium, amnesia,experience; use of the drug can cause delirium, amnesia,
depression, and long-term memory and cognitive difficultiesdepression, and long-term memory and cognitive difficulties
(“Ketamine,” 2001)(“Ketamine,” 2001)
Treatment:Treatment: Symptoms are treated with anti-psychotics, particularlySymptoms are treated with anti-psychotics, particularly
ClozapineClozapine
FYI:FYI: Analogue of PCP; the only known source of Ketamine is viaAnalogue of PCP; the only known source of Ketamine is via
diversion of pharmaceutical products (“Ketamine,” 2001); in adiversion of pharmaceutical products (“Ketamine,” 2001); in a
2004 NY survey of club-drug users, 72% reported having used2004 NY survey of club-drug users, 72% reported having used
Ketamine (“Club drugs,” 2005); due to its dissociative effect, itKetamine (“Club drugs,” 2005); due to its dissociative effect, it
is reportedly used as a date-rape drug (“Ketamine,” 2001)is reportedly used as a date-rape drug (“Ketamine,” 2001)

We’re Getting ThereWe’re Getting There

Over-The-Counter and Quasi-Legal Drugs:Over-The-Counter and Quasi-Legal Drugs:
Nitrous OxideNitrous Oxide

AKA:AKA: DXM, Orange Crush, Triple C's, C-C-C, Red Devils, Skittles,DXM, Orange Crush, Triple C's, C-C-C, Red Devils, Skittles,
Dex, Vitamin D, Robo, Robo-trippin', Robo-dosingDex, Vitamin D, Robo, Robo-trippin', Robo-dosing
Forms:Forms: capsule, liquid, liquid gelatin capsule, lozenge, tablet, powdercapsule, liquid, liquid gelatin capsule, lozenge, tablet, powder
Effect:Effect: High dose will cause users to feel very spacey and “out of it”;High dose will cause users to feel very spacey and “out of it”;
impairs motor control and causes robot-like movements; canimpairs motor control and causes robot-like movements; can
produce panic attacks and audio and visual hallucinations; canproduce panic attacks and audio and visual hallucinations; can
cause nausea and itchy skin (“DXM,” n.d.); can cause death ascause nausea and itchy skin (“DXM,” n.d.); can cause death as
well as other serious adverse events such as brain damage, seizure,well as other serious adverse events such as brain damage, seizure,
loss of consciousness, and irregular heart beatloss of consciousness, and irregular heart beat
Treatment:Treatment: none notednone noted
FYI:FYI: often sold as ‘Ecstasy’; high doses of DXM have contributed tooften sold as ‘Ecstasy’; high doses of DXM have contributed to
numerous cases of rave-related heatstroke (“DXM,” n.d.); DXMnumerous cases of rave-related heatstroke (“DXM,” n.d.); DXM
is an ingredient found in any cold medicine with "DM" or "Tuss"is an ingredient found in any cold medicine with "DM" or "Tuss"
in the title or name (approx. 70 of them) (“Dextromethorphan,”in the title or name (approx. 70 of them) (“Dextromethorphan,”
2005)2005)

Nitrous OxideNitrous Oxide
AKA:AKA: Laughing Gas; Cartridges; Hippy Crack; N2OLaughing Gas; Cartridges; Hippy Crack; N2O
Forms:Forms: GasGas
Use/Effect:Use/Effect: Anaesthetic (primarily in dentistry); The primary dangers ofAnaesthetic (primarily in dentistry); The primary dangers of
nitrous inhalation are: oxygen deprivation, frost bite, loss ofnitrous inhalation are: oxygen deprivation, frost bite, loss of
motor control, vitamin B12 interference, folic acidmotor control, vitamin B12 interference, folic acid
interference, respiratory depression, apnea, diffusioninterference, respiratory depression, apnea, diffusion
hypoxia, hypotension, arrhythmias, dizziness, euphoria,hypoxia, hypotension, arrhythmias, dizziness, euphoria,
increased cerebral blood flow/intracranial pressure,increased cerebral blood flow/intracranial pressure,
neuropathy with chronic exposure, nausea, vomiting, ileus,neuropathy with chronic exposure, nausea, vomiting, ileus,
bone marrow depression with chronic exposure, malignantbone marrow depression with chronic exposure, malignant
hyperthermiahyperthermia
Treatment:Treatment: none notednone noted
FYI:FYI: SEE NEXT SLIDESEE NEXT SLIDE

What's mistake but a kind of take?What's mistake but a kind of take?
What's nausea but a kind of -usea?What's nausea but a kind of -usea?
Sober, drunk, -unk, astonishment.Sober, drunk, -unk, astonishment.
Everything can become the subject of criticism -- how criticise withoutEverything can become the subject of criticism -- how criticise without
something to criticise?something to criticise?
Agreement -- disagreement!!Agreement -- disagreement!!
Emotion -- motion!!!Emotion -- motion!!!
By God, how that hurts! By God, how it doesn't hurt! Reconciliation of twoBy God, how that hurts! By God, how it doesn't hurt! Reconciliation of two
extremes.extremes.
By George, nothing but othing!By George, nothing but othing!
That sounds like nonsense, but it's pure onsense!That sounds like nonsense, but it's pure onsense!
Thought much deeper than speech...!Thought much deeper than speech...!
Medical school; divinity school, school! SCHOOL! Oh my God, oh God; ohMedical school; divinity school, school! SCHOOL! Oh my God, oh God; oh
God!God!
The most coherent and articulate sentence which came was this:The most coherent and articulate sentence which came was this:
There are no differences but differences of degree between different degreesThere are no differences but differences of degree between different degrees
of difference and no difference.of difference and no difference.

Guess Who…Guess Who…
WILLIAM JAMESWILLIAM JAMES
Father of American PsychologyFather of American Psychology
&&
Nitrous Oxide EnthusiastNitrous Oxide Enthusiast

QuestionsQuestions
1)1) Dissociative Anaesthetics work by altering the levels of whatDissociative Anaesthetics work by altering the levels of what
neurotransmitter?neurotransmitter?
a)a) GlutamateGlutamate
b)b) EpinephrineEpinephrine
c)c) AcetylcholineAcetylcholine
d)d) NorepinephrineNorepinephrine

QuestionsQuestions
2)2) Depressed respiration is uncommon with this anaestheticDepressed respiration is uncommon with this anaesthetic
making it more suitable for use with children.making it more suitable for use with children.
a)a) DXMDXM
b)b) PCPPCP
c)c) TiletamineTiletamine
d)d) KetamineKetamine

QuestionsQuestions
3)3) Research suggests that this anaesthetic may prove beneficial inResearch suggests that this anaesthetic may prove beneficial in
the treatment of cocaine addiction.the treatment of cocaine addiction.
a)a) KetamineKetamine
b)b) GlutamateGlutamate
c)c) AmantadineAmantadine
d)d) PhencyclidinePhencyclidine

ReferencesReferences
(No date). DXM.(No date). DXM. E-Z TestE-Z Test. Retrieved June 12 2004 from. Retrieved June 12 2004 from
www.eztest.com/cms/index.php?www.eztest.com/cms/index.php?
option=com_content&task=view&id=28&Itemid=53.option=com_content&task=view&id=28&Itemid=53.
(2001) Ketamine.(2001) Ketamine. DEA: U.S. Drug Enforcement AdministrationDEA: U.S. Drug Enforcement Administration..
Retrieved June 11, 2005 fromRetrieved June 11, 2005 from
www.usdoj.gov/dea/ketamine_factsheet.htmlwww.usdoj.gov/dea/ketamine_factsheet.html
(2001) Phencyclidine (PCP).(2001) Phencyclidine (PCP). DEA: U.S. Drug EnforcementDEA: U.S. Drug Enforcement
AdministrationAdministration. Retrieved June 11, 2005 from. Retrieved June 11, 2005 from
www.usdoj.gov/dea/ketamine_factsheet.html.www.usdoj.gov/dea/ketamine_factsheet.html.
(2004 November). Alternatives to the flu vaccine.(2004 November). Alternatives to the flu vaccine. Cortland ForumCortland Forum,,
Vol. 17 Issue 11, p20.Vol. 17 Issue 11, p20.
(2005 May). Amantadine for weight gain during olanzapine(2005 May). Amantadine for weight gain during olanzapine
treatment.treatment. Brown University Psychopharmacology UpdateBrown University Psychopharmacology Update, Vol. 16, Vol. 16
Issue 5, p4.Issue 5, p4.
(2005 February). Club drugs: Study explores reasons for use by(2005 February). Club drugs: Study explores reasons for use by
young adults.young adults. DATA: The Brown University Digest of AddictionDATA: The Brown University Digest of Addiction
Theory & Application,Theory & Application, Vol. 24 Issue 2, p1.Vol. 24 Issue 2, p1.
Brown, T.B., Lovato, L.M., Parker, D. (2005 January). ProceduralBrown, T.B., Lovato, L.M., Parker, D. (2005 January). Procedural
Sedation in the Acute Care Setting.Sedation in the Acute Care Setting. American FamilyAmerican Family
PhysicianPhysician, Vol. 71 Issue 1, p85., Vol. 71 Issue 1, p85.
Dextromethorphan (DXM).Dextromethorphan (DXM). Streetdrugs.orgStreetdrugs.org. Retrieved June 13,. Retrieved June 13,
2005 from www.streetdrugs.org/dxm.htm.2005 from www.streetdrugs.org/dxm.htm.
Douglas, M.W., Johnson, R.W., Cunningham, A.L. (2004).Douglas, M.W., Johnson, R.W., Cunningham, A.L. (2004).
Tolerability of Treatments for Postherpetic Neuralgia.Tolerability of Treatments for Postherpetic Neuralgia. DrugDrug
SafetySafety, Vol. 27 Issue 15, p1217., Vol. 27 Issue 15, p1217.
James, William. (1882). Subjective Effects of Nitrous Oxide.James, William. (1882). Subjective Effects of Nitrous Oxide.
Mind,Mind, Vol 7.Vol 7.
Kikawada, M., Iwamoto, T., Takasaki, M. (2005). Aspiration andKikawada, M., Iwamoto, T., Takasaki, M. (2005). Aspiration and
Infection in the Elderly: Epidemiology, Diagnosis andInfection in the Elderly: Epidemiology, Diagnosis and
Management.Management. Drugs & AgingDrugs & Aging, Vol. 22 Issue 2, p115., Vol. 22 Issue 2, p115.
Masi, G. (2004). Pharmacotherapy of Pervasive DevelopmentalMasi, G. (2004). Pharmacotherapy of Pervasive Developmental
Disorders in Children and Adolescents.Disorders in Children and Adolescents. CNS DrugsCNS Drugs, Vol. 18, Vol. 18
Issue 14, p1031.Issue 14, p1031.
Rench-Mullen, J.M., Lehmann, J., Bohacek, R., Fisher, R.S.Rench-Mullen, J.M., Lehmann, J., Bohacek, R., Fisher, R.S.
(1987). Tiletamine is a potent inhibitor of N-methyl-(1987). Tiletamine is a potent inhibitor of N-methyl-
aspartate-induced depolarizations in rat hippocampus andaspartate-induced depolarizations in rat hippocampus and
striatum.striatum. American Society for Pharmacology and ExperimentalAmerican Society for Pharmacology and Experimental
TherapeuticsTherapeutics, Volume 243, Issue 3, pp. 915-920., Volume 243, Issue 3, pp. 915-920.
Sofuoglu, M., Kosten, T.R. (2005). Novel Approaches to theSofuoglu, M., Kosten, T.R. (2005). Novel Approaches to the
Treatment of Cocaine Addiction.Treatment of Cocaine Addiction. CNS Drugs,CNS Drugs, Vol. 19 IssueVol. 19 Issue
1, p13.1, p13.
Smith, J.P., Riley III, T.R., Devenyi, A., Bingaman, S.I.,Smith, J.P., Riley III, T.R., Devenyi, A., Bingaman, S.I.,
Kunselman, A. (2004 June). Amantadine Therapy forKunselman, A. (2004 June). Amantadine Therapy for
Chronic Hepatitis C.Chronic Hepatitis C. Journal of General Internal MedicineJournal of General Internal Medicine, Vol., Vol.
19 Issue 6, p662.19 Issue 6, p662.

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