Possible Interaction: Epinephrine and Ketamine

“During ketamine anesthesia, both epinephrine (15 ± 10 pg/ml to 256 ± 193 pg/ml) and norepinephrine (250 ± 105 pg/ml to 570 ± 270 pg/ml) plasma concentrations significantly increased, as did heart rate (67 ± 13 beats/min to 113 ± 15 beats/min).”

“… Ketamine (500 &mgr;m) suppressed … (0.5 &mgr;m), epinephrine (1 &mgr;m), (+)-9,11-epithia-11,12-methano-TXA2 (STA2) (0.5 &mgr;m), and thrombin (0.02 U/… ± 30.9, 46.3 ± 4.3, −2.0 ± 16.8, and 86.6 ± 1.4% of zero-control, respectively.”

“Intravenous ketamine dissociation anesthesia combined with epinephrine solution infiltration may provoke serious tachyarrhythmias despite diazepam premedication and the use of minimal doses of both drugs.”

“ Ketamine alone did not produce motor block, but addition of adrenaline resulted in complete motor block, and may have intensified sensory blockade.”

“ Adrenalin plays an important role in the control of duration of ketamine anesthesia, while noradrenalin, dopamine and corticosterone have no such function.”

“A subthreshold dose … each isomer of ketamine (10(-4) mol litre-1) which alone did not relax histamine-induced contraction (…(+), P < 0.01; R(+/-), P < 0.01; R(-), P < 0.05) significantly potentiated adrenaline 1.25-5.0 x 10(-9) mol …-1-induced relaxation (potency: S(+) > R(+/-) > R(-)).”

“We conclude that although both ketamine isomers produced equipotent spasmolytic effects on airway smooth muscle precontracted with histamine, they differed in their ability to potentiate the relaxing effect of adrenaline.”

“In chronically catheterized rats, diethyl ether, ketamine and urethane increased plasma adrenaline (A) and noradrenaline (NA) concentrations, indicating that these drugs stimulate both neurosympathetic and adrenomedullary functions.”

“Ketamine potentiated, whereas cocaine inhibited, responses to tyramine Experiments using the technique of oil immersion demonstrated that ketamine reduced the rate at which aortic strips inactivate adrenaline even when monoamine oxidase (MAO) and neuronal uptake processes were fully inhibited.”

“Uptake studies showed that ketamine and 17 beta-estradiol reduced extraneuronal accumulation of [3H]adrenaline in aortic strips.”

“This action took place with ketamine concentrations found in anaesthetic plasma concentrations, i.e., 1 x 10(-5) to 2 x 10(-4) M.3 Ketamine (10(-5) to 10(-3) M) dose-dependently attenuated contractions induced by adrenaline , noradrenaline, angiotensin II, vasopressin and KCl.”

“ Ketamine significantly increased brain epinephrine (25%), serotonin (28%) and 5-hydroxy indoleacetic acid (32%) in rats.”

“The increase in epinephrine (13%) and decrease in norepinephrine (31%) and dopamine (38%) levels remained significant 12 hours after ketamine injection.”