Dissociative

Anaesthetics
Jerry D. Smith Jr.
14 June 2005
 Dissociative
Anaesthetics

“…distort perceptions of sight and

sound and produce feelings of
detachment—dissociation—from the
environment and self.”
- US Dept. of Health and Human
Services
 Dissociative
Anaesthetics
How They Work:

• Alter distribution of glutamate

throughout the brain

• Glutamate is involved in perception

of pain, responses to the
environment, and memory
Dissociative
Anaesthetics
Who They Are

Prescription Drugs:

Ketamine
Tiletamine
Amantadine
 Dissociative
Anaesthetics
Ketamine

AKA: Ketamil (vet medicine), Ketalar, Amidate, Brevital,

Diprivan, E-thrane, Fluothane, Forane, Penthrane,
Pentothal
Forms: liquid
Use: veterinary and human anaesthetic
FYI: agent of choice in paediatrics, shock patients,
asthmatics, and burn patients because depressed
respiration is uncommon; effective in treating
Postherpetic Neuralgia (Douglas, Johnson, &
Cunningham, 2004; Brown, Lovato, & Parker, 2005)
 Dissociative
Anaesthetics
Tiletamine

AKA: Zoletic, Telazol

Forms: tablet, liquid
Use: veterinary anaesthetic
FYI: similar to ketamine and phencyclidine in chemical
structure and action (Rench-Mullen, Lehmann,
Bohacek, & Fisher, 1987)
 Dissociative
Anaesthetics
Amantadine
Amantadine
AKA: Symmetrel
Forms: capsule, tablet, syrup
Use: Antidyskinetic, Antifatigue (specifically in multiple
sclerosis), Antiviral; used to treat Parkinson's disease,
influenza, Hepatitis C, aspiration in the elderly; used to
temporarily limit or reverse weight gain associated with
olanzapine (Zyprexa) treatment in patients with
schizophrenia, schizoaffective disorder,
schizophreniform disorder, or bipolar I disorder (Masi,
2004; “Amantadine for weigh”, 2005; “Alternatives to
the flu”, 2004; Smith, Riley III, Devenyi, Bingaman,
Kunelman, 2004; Kikawada, Iwamoto, Tarasaki, 2005)
FYI: ongoing research indicates may be effective in
treatment of cocaine users with high withdrawal
severity (Sofuoglu & Kosten, 2005)
Dissociative
Anaesthetics
Who They Are

Street Drugs:

Phencyclidine
Ketamine
Dextromethorphan
 Dissociative
Anaesthetics
Phencyclidine
AKA: PCP, Angel Dust, Embalming Fluid, PeaCe Pill, Boat,
Dummy Dust, Love Boat, Supergrass, Killer Weed,
Ozone, Rocket Fuel, Wack, etc.
Forms: powder, liquid, tablet, or on smoking material
Effect: Numbness, slurred speech, loss of coordination, rapid
and involuntary eye movements, auditory
hallucinations, image distortion, severe mood
disorders, amnesia, in some users PCP use may result
in acute anxiety, a feeling of impending doom,
paranoia, violent hostility, and in some it may
produce a psychoses indistinguishable from
schizophrenia (“Phencyclidine,” 2001)
Treatment: Symptoms are treated with anti-psychotics,
particularly Haloperidol (Haldol)
FYI: Originally designed as a human anaesthetic and later
produced only as a veterinary anaesthetic, PCP is no
longer produced or used for legitimate purposes
because of postoperative psychoses
(“Phencyclidine,” 2001)
 Dissociative
Anaesthetics
Ketamine
AKA: K, Special-K, Vitamin-K, Jet, Super Acid, Green,
Cat Valium
Forms: liquid, powder
Effect: At lower doses it has a mild, dreamy feeling;
users report feeling floaty and slightly outside
their body; numbness in the extremities is also
common; higher doses produce an effect
referred to as "K-Hole," an "out of body," or
"near-death" experience; use of the drug can
cause delirium, amnesia, depression, and long-
term memory and cognitive difficulties
(“Ketamine,” 2001)
Treatment: Symptoms are treated with anti-psychotics,
particularly Clozapine
FYI: Analogue of PCP; the only known source of
Ketamine is via diversion of pharmaceutical
products (“Ketamine,” 2001); in a 2004 NY
survey of club-drug users, 72% reported having
 Dissociative
Anaesthetics
Dextromethorphan

We’re Getting There

 Dissociative
Anaesthetics
Who They Are

Over-The-Counter and Quasi-Legal

Drugs:

Dextromethorphan
Nitrous Oxide
 Dissociative
Anaesthetics
Dextromethorphan
AKA: DXM, Orange Crush, Triple C's, C-C-C, Red Devils,
Skittles, Dex, Vitamin D, Robo, Robo-trippin',
Robo-dosing
Forms: capsule, liquid, liquid gelatin capsule, lozenge,
tablet, powder
Effect: High dose will cause users to feel very spacey and
“out of it”; impairs motor control and causes
robot-like movements; can produce panic attacks
and audio and visual hallucinations; can cause
nausea and itchy skin (“DXM,” n.d.); can cause
death as well as other serious adverse events
such as brain damage, seizure, loss of
consciousness, and irregular heart beat
Treatment: none noted
FYI: often sold as ‘Ecstasy’; high doses of DXM have
contributed to numerous cases of rave-related
heatstroke (“DXM,” n.d.); DXM is an ingredient
 Dissociative
Anaesthetics
Nitrous Oxide
Nitrous Oxide

AKA: Laughing Gas; Cartridges; Hippy Crack; N2O

Forms: Gas
Use/Effect: Anaesthetic (primarily in dentistry); The
primary dangers of nitrous inhalation are:
oxygen deprivation, frost bite, loss of motor
control, vitamin B12 interference, folic acid
interference, respiratory depression, apnea,
diffusion hypoxia, hypotension, arrhythmias,
dizziness, euphoria, increased cerebral blood
flow/intracranial pressure, neuropathy with
chronic exposure, nausea, vomiting, ileus,
bone marrow depression with chronic
exposure, malignant hyperthermia
Treatment: none noted
 Dissociative
Anaesthetics
What's mistake but a kind of take?
What's nausea but a kind of -usea?
Sober, drunk, -unk, astonishment.
Everything can become the subject of criticism -- how
criticise without something to criticise?
Agreement -- disagreement!!
Emotion -- motion!!!
By God, how that hurts! By God, how it doesn't hurt!
Reconciliation of two extremes.
By George, nothing but othing!
That sounds like nonsense, but it's pure onsense!
Thought much deeper than speech...!
Medical school; divinity school, school! SCHOOL! Oh my
God, oh God; oh God!

The most coherent and articulate sentence which came was

this:
There are no differences but differences of degree between
different degrees of difference and no difference.
 Dissociative
Anaesthetics
Guess Who…

WILLIAM JAMES
Father of American Psychology
&
Nitrous Oxide Enthusiast
 Dissociative
Anaesthetics
Questions

1) Dissociative Anaesthetics work by altering the

levels of what neurotransmitter?
 Glutamate
 Epinephrine
 Acetylcholine
 Norepinephrine
 Dissociative
Anaesthetics
Questions

2) Depressed respiration is uncommon with this

anaesthetic making it more suitable for use with
children.
 DXM
 PCP
 Tiletamine
 Ketamine
 Dissociative
Anaesthetics
Questions

3) Research suggests that this anaesthetic may

prove beneficial in the treatment of cocaine
addiction.
 Ketamine

 Glutamate

 Amantadine

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