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Latest & greatest articles for ketamine
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Low-dose ketamine improves pain relief in patients receiving intravenous opioids for acute pain in the emergency department: results of a randomized, double-blind, clinical trial Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care (...) ) morphine and normal saline placebo (standard care group), 2) morphine and 0.15 mg/kg ketamine (group 1), or 3) morphine and 0.3 mg/kg ketamine (group 2). Participants were assessed at 30, 60, and 120 minutes after study medication administration and received rescue analgesia as needed to target a 50% reduction in pain. The primary outcome measure of pain relief, or pain intensity reduction, was derived using the NRS and calculated as the summed pain-intensity (SPID) difference over 2 hours. The amount
Ketamine in outpatient arthroscopic shoulder surgery: Effects on postoperative pain, hemodynamic stability and process times. Pain after arthroscopic shoulder surgery is often severe, and establishing a pain treatment regimen that does not delay discharge can be challenging. The reported ability of ketamine to prevent opioid-induced hyperalgesia has not been investigated in this particular setting.300 adult patients scheduled for shoulder arthroscopy under general anesthesia were recruited (...) for this observational clinical trial and were allotted to either receive 1mg/kg IV bolus of ketamine before surgery (ketamine group, KG) or to a control group (CG) without ketamine. NRS pain scores were obtained on the operative day and on postoperative days 1 and 2 and compared between groups. Secondary variables were blood pressure, heart rate, process times, satisfaction with the anesthetic and unwanted effects.Pain severity did not differ significantly between the groups at any time. Propofol injection rate
Ketamine for adult patients who have suffered painful and traumatic injuries: a Review of Clinical Effectiveness, Cost-Effectiveness, Safety and Guidelines Ketamine for adult patients who have suffered painful and traumatic injuries: a Review of Clinical Effectiveness, Cost-Effectiveness, Safety and Guidelines Ketamine for adult patients who have suffered painful and traumatic injuries: a Review of Clinical Effectiveness, Cost-Effectiveness, Safety and Guidelines CADTH Record Status (...) This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation CADTH. Ketamine for adult patients who have suffered painful and traumatic injuries: a Review of Clinical Effectiveness, Cost-Effectiveness, Safety and Guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response - Summary with Critical Appraisal. 2014 Authors' conclusions One study failed
Intravenous ketamine for the treatment of pain syndromes: clinical effectiveness Intravenous ketamine for the treatment of pain syndromes: clinical effectiveness Intravenous ketamine for the treatment of pain syndromes: clinical effectiveness CADTH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation CADTH. Intravenous ketamine (...) for the treatment of pain syndromes: clinical effectiveness. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response - Summary of Abstracts. 2013 Authors' conclusions One systematic review, two randomized controlled trials, and four non-randomized studies were identified regarding the clinical effectiveness of intravenous (IV) ketamine for the treatment of chronic regional pain syndrome. No health technology assessments, systematic reviews, randomized controlled trials, or non
Chronic pain: oral ketamine Chronic pain: or Chronic pain: oral k al ketamine etamine Evidence summary Published: 25 February 2014 nice.org.uk/guidance/esuom27 pathways K Ke ey points from the e y points from the evidence vidence The content of this evidence summary was up-to-date in February 2014. See summaries of product characteristics (SPCs), British national formulary (BNF), BNF for children (BNFc) or the MHRA or NICE websites for up-to-date information. Summary Two small, short-term (...) , randomised, placebo-controlled trials and 1 small case series of n-of-1 trials provide no good quality evidence for the use of oral ketamine to treat chronic pain in adults. Only 1 phase I pilot study in young people was identified but this was too small and short-term to draw any firm conclusions about the efficacy and safety of oral ketamine for treating chronic pain in young people. In the studies that reported safety, oral ketamine was frequently associated with adverse effects that often resulted
Randomized, Double-Blinded, Clinical Trial of Propofol, 1:1 Propofol/Ketamine, and 4:1 Propofol/Ketamine for Deep Procedural Sedation in the Emergency Department We compare the frequency of airway and respiratory adverse events leading to an intervention between propofol with 1:1 and 4:1 mixtures of propofol and ketamine (ketofol).We performed a randomized, double-blinded trial in which emergency department adults undergoing deep sedation received propofol, 1:1 propofol and ketamine, or 4:1 (...) propofol and ketamine. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, procedure and recovery time, patient satisfaction, pain, and procedural recall.Two hundred seventy-one subjects completed the trial, 90 receiving propofol, 85 receiving 1:1 propofol and ketamine, and 96 receiving 4:1 propofol and ketamine. Airway or respiratory adverse events leading to an intervention were similar between
Intravenous ketamine for the treatment of mental health disorders: a review of clinical effectiveness and guidelines Intravenous ketamine for the treatment of mental health disorders: a review of clinical effectiveness and guidelines Intravenous ketamine for the treatment of mental health disorders: a review of clinical effectiveness and guidelines CADTH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality (...) of this assessment has been made for the HTA database. Citation CADTH. Intravenous ketamine for the treatment of mental health disorders: a review of clinical effectiveness and guidelines. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH). Rapid Response. 2014 Authors' conclusions Major Depressive Disorder (MDD)Current evidence has consistently shown that IV ketamine may improve symptoms scored by the MADRS and HAM-D scoring tools at 24 hours in patients with MDD. However, identifying which
Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial Ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, has shown rapid antidepressant effects, but small study groups and inadequate control conditions in prior studies have precluded a definitive conclusion. The authors evaluated the rapid antidepressant efficacy of ketamine in a large group of patients with treatment-resistant major depression.This was a two-site (...) , parallel-arm, randomized controlled trial of a single infusion of ketamine compared to an active placebo control condition, the anesthetic midazolam. Patients with treatment-resistant major depression experiencing a major depressive episode were randomly assigned under double-blind conditions to receive a single intravenous infusion of ketamine or midazolam in a 2:1 ratio (N=73). The primary outcome was change in depression severity 24 hours after drug administration, as assessed by the Montgomery
Intravenous Ketamine for the Treatment of Pain Syndromes TITLE: Intravenous Ketamine for the Treatment of Pain Syndromes: Clinical Effectiveness DATE: 07 June 2013 RESEARCH QUESTIONS 1. What is the clinical effectiveness of intravenous (IV) ketamine for the treatment of recalcitrant chronic regional pain syndrome? 2. What is the clinical effectiveness of IV ketamine for the treatment of fibromyalgia? 3. What is the clinical effectiveness of IV ketamine for the treatment of reflex sympathetic (...) dystrophy? KEY MESSAGE One systematic review, two randomized controlled trials, and four non-randomized studies were identified regarding the clinical effectiveness of intravenous (IV) ketamine for the treatment of chronic regional pain syndrome. No health technology assessments, systematic reviews, randomized controlled trials, or non-randomized studies were identified regarding the clinical effectiveness of IV ketamine for the treatment of fibromyalgia or reflex sympathetic dystrophy. METHODS
Opioid-sparing effect of preemptive bolus low-dose ketamine for moderate sedation in opioid abusers undergoing extracorporeal shock wave lithotripsy: a randomized clinical trial Ketamine has been used as part of a multimodal analgesia regime in opioid abusers undergoing general anesthesia. We studied the opioid-sparing effect of a very low-dose bolus of ketamine as part of moderate sedation for opioid abuse patients undergoing extracorporeal shock wave lithotripsy.In this randomized, placebo (...) -controlled clinical trial, 190 opioid abusers were enrolled. They were stratified into 2 blocks based on their daily opioid consumption. Both blocks were then randomized to receive 0.1 mg/kg IV ketamine (group K) or placebo (group P). Lithotripsy was performed under moderate sedation with intermittent bolus doses of remifentanil (0.2 µg/kg) to alleviate pain. The total remifentanil dose (primary outcome) and respiratory adverse events (secondary outcome) were compared in the 2 groups.Remifentanil
Is Ketamine Effective for the Management of Acute Asthma Exacerbations in Children? Systematic Review Snapshot TAKE-HOME MESSAGE Limited data from a single randomized controlled trial do not support the routine use of ketamine for children with acute asthma exacerbations that are unresponsive to initial aerosolized b 2 -agonist or steroids. Is Ketamine Effective for the Management of Acute Asthma Exacerbations in Children? EBEM Commentators Randolph P. Maddox, MD Rawle A. Seupaul, MD Department (...) of Emergency Medicine University of Arkansas for Medical Sciences Little Rock, AR Results Estimated bene?t of ketamine compared to placebo for children with acute asthma exacerbation that fail standard therapy based on a single trial (N¼68). Time Pulmonary Index Score (Mean Difference) 95% Con?dence Interval 2 h 0.40 (–0.4 to 1.3) The search identi?ed 5 potential studies; only 1 trial 2 met inclusion criteria so a meta-analysis could not be performed. This trial was appro- priately powered to detect
Adjunctive Atropine Versus Metoclopramide: Can We Reduce Ketamine-associated Vomiting in Young Children? A Prospective, Randomized, Open, Controlled Study Pediatric procedural sedation and analgesia (PPSA) with ketamine administration occurs commonly in the emergency department (ED). Although ketamine-associated vomiting (KAV) is a less serious complication of ketamine administration, it seems to be cumbersome and not uncommon. The authors evaluated the incidence of KAV and the prophylactic (...) effect of adjunctive atropine and metoclopramide in children receiving ketamine sedation in the ED setting.This prospective, randomized, open, controlled study was conducted in children receiving ketamine sedation in the ED of a university-affiliated, tertiary hospital with 85,000 ED visits, including 32,000 pediatric patients from October 2010 to September 2011. The primary outcome was a measure of the incidence of KAV in the ED and after discharge according to the adjunctive drug administered
Ketamine as an adjuvant to opioids for cancer pain. This is an update of the original review published in Issue 1, 2003. Ketamine is a commonly used anaesthetic agent, and in subanaesthetic doses is also given as an adjuvant to opioids for the treatment of cancer pain, particularly when opioids alone prove to be ineffective. Ketamine is known to have psychotomimetic (including hallucinogenic), urological and hepatic adverse effects.To determine the effectiveness and adverse effects of ketamine (...) as an adjuvant to opioids in the treatment of cancer pain.Studies were originally identified from MEDLINE (1966 to 2002), EMBASE (1980 to 2002), CancerLit (1966 to 2002), The Cochrane Library (Issue 1, 2001); by handsearching reference lists from review articles, trials, and chapters from standard textbooks on pain and palliative care. The manufacturer of ketamine (Pfizer Parke-Davis) provided search results from their in-house database, PARDLARS.An improved and updated search of the following was performed
Ketamine for management of acute exacerbations of asthma in children. Asthma is the most common chronic disease in children, and children with asthma frequently visit the paediatric emergency departments with acute exacerbations. Some of these children fail to respond to standard therapy (aerosol beta(2)-agonist with or without aerosol anticholinergic and oral or parenteral corticosteroids) for acute asthma leading to prolonged emergency department stay, hospitalisation, morbidity (e.g (...) . barotrauma, intubation) and death, albeit rarely. Ketamine may relieve bronchospasm and is a potentially promising therapy for children with acute asthma who fail to respond to standard treatment.To evaluate the efficacy of ketamine compared to placebo, no intervention or standard care for management of severe acute asthma in children who had not responded to standard therapy.We identified trials from the Cochrane Airways Group Specialised Register of trials (CAGR) and ClinicalTrials.gov. We reviewed
The effect of perioperative intravenous lidocaine and ketamine on recovery after abdominal hysterectomy Perioperative ketamine infusion reduces postoperative pain; perioperative lidocaine infusion reduces postoperative narcotic consumption, speeds recovery of intestinal function, improves postoperative fatigue, and shortens hospital stay. However, it is unknown whether perioperative IV lidocaine and/or ketamine enhances acute functional recovery. We therefore tested the primary hypothesis (...) that perioperative IV lidocaine and/or ketamine in patients undergoing open abdominal hysterectomy improves rehabilitation as measured by a 6-minute walk distance (6-MWD) on the second postoperative morning.Women having open hysterectomy were anesthetized with sevoflurane, followed by patient-controlled morphine. Patients were factorially randomized to one of the following groups: (1) lidocaine and placebo, (2) placebo and ketamine, (3) placebo and placebo, or (4) lidocaine and ketamine. Lidocaine was given
Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial We determine whether a 1:1 mixture of ketamine and propofol (ketofol) for emergency department (ED) procedural sedation results in a 13% or more absolute reduction in adverse respiratory events compared with propofol alone.Participants were randomized to receive either ketofol or propofol in a double-blind fashion. Inclusion criteria were aged
Morphine and Ketamine Is Superior to Morphine Alone for Out-of-Hospital Trauma Analgesia: A Randomized Controlled Trial We assess the efficacy of intravenous ketamine compared with intravenous morphine in reducing pain in adults with significant out-of-hospital traumatic pain.This study was an out-of-hospital, prospective, randomized, controlled, open-label study. Patients with trauma and a verbal pain score of greater than 5 after 5 mg intravenous morphine were eligible for enrollment (...) . Patients allocated to the ketamine group received a bolus of 10 or 20 mg, followed by 10 mg every 3 minutes thereafter. Patients allocated to the morphine alone group received 5 mg intravenously every 5 minutes until pain free. Pain scores were measured at baseline and at hospital arrival.A total of 135 patients were enrolled between December 2007 and July 2010. There were no differences between the groups at baseline. After the initial 5-mg dose of intravenous morphine, patients allocated to ketamine
The Reduction Of The Adverse Effects Of Ketamine When Combined With Midazolam During Anesthesia UTCAT2287, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title The Reduction Of The Adverse Effects Of Ketamine When Combined With Midazolam During Anesthesia Clinical Question In the anesthetized patient, does the combination of ketamine (Ketalar) with midazolam (Versed) reduce the adverse effects (hallucinations) produced (...) by ketamine when it is used alone? Clinical Bottom Line The combination of ketamine and midazolam reduces the adverse effects produced by ketamine when it is used alone. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Sener/2011 182 adult emergency department patients; 18-50 years old Randomized double blind trial Key results Less recovery agitation was shown in patients receiving midazolam (8% versus 25
Procedural sedation with propofol for painful orthopaedic manipulation in the emergency department expedites patient management compared with a midazolam/ketamine regimen: a randomized prospective study The use of procedural sedation and analgesia to allow painful orthopaedic manipulations in the emergency department has become a standard practice over the last decade. Both propofol and midazolam/ketamine are attractive sedative regimens for routine use in the emergency department. We (...) hypothesized that sedation with propofol as compared with midazolam/ketamine will save time in the emergency department. The purpose of the present study was to compare the recovery time, the total sedation time, and the adverse events of procedural sedation and analgesia induced with propofol as compared with midazolam/ketamine.This prospective randomized study was conducted in the emergency department of a tertiary care, university-affiliated medical center. All sedations and orthopaedic manipulations