Ketamine Sickle Cell Disease
Ketamine Sickle Cell Disease
Sickle cell disease (SCD) often results in acute vaso-occlusive crisis (VOC), an obstruction
 of blood vessels resulting in ischemic injury and pain. The pain experienced during these
 episodes is due to a wide range of pathophysiological processes. Though recent studies have
 begun to unravel the underlying mechanisms of these processes, literature focused on pain
 management for sickle cell disease is scarce. Opioids and non-steroidal anti-inflammatory
 drugs (NSAIDs) remain the predominate treatment for VOC.

 However, the efficacy of these treatments has come into question. A large sub-set of patients
 with SCD report continued pain despite treatment with opioids. Tolerance and opioid-induced
 hyperalgesia (OIH) may be responsible for unresponsiveness to opioid-centric treatment
 modalities. New classes of drugs are being tested to prevent and treat acute pain associated
 with SCD, but in the meantime physicians are looking to existing therapies to bridge the gap.

 The N-methyl-d-aspartate (NMDA) receptor has been implicated in both tolerance and OIH. As a
 NMDA receptor agonist, ketamine has been shown to modulate opioid tolerance and OIH in animal
 models and clinical settings. Ketamine utilized as a low dose continuous infusion could
 benefit patients with SCD related pain that are unresponsive to opioid analgesics. Based on
 limited studies of adjuvant ketamine use for pain management, low-dose ketamine continuous
 infusion appears safe. Further clinical investigations are warranted to fully support the use
 of low-dose ketamine infusion in patients with SCD-related pain.
Inclusion Criteria:

 -  Subjects diagnosed with sickle cell anemia

 -  Adults aged 18 and older

 -  Subjects who have given written consent

 Exclusion Criteria:

 -  Subjects who are pregnant

 -  Subjects younger than 18 years

 -  Subjects known or suspected to have an allergy to opiates/opioids, muscle relaxants or
 other similar medications

 -  Subjects who have a contraindication to ketamine