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Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events Journal Club Eastern Virginia Medical School Therapy Article Presenter: Allison Wood Date: 8/31/20 Citation: Conway, J., et al, Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events. Critical Care Medicine, 47, p.498. I. WHAT IS BEING STUDIED? 1. Study Objective To study “whether (...) the administration of ketamine for tracheal intubation in critically ill children with or without shock was associated with fewer adverse hemodynamic events compared with other induction agents.” “We also investigated if there was a dose dependence for any association between ketamine use and adverse hemodynamic events.” 2. Study Design Retrospective analysis of prospectively collected observational data from the NEAR4KIDS and PALISI databases that included 40 PICU’s in US & Canada 3. Inclusion Criteria All
Ketamine Procedural Sedation for Children in EDs The Royal College of Emergency Medicine Best Practice Guideline KETAMINE PROCEDURAL SEDATION FOR CHILDREN IN THE EMERGENCY DEPARTMENT Revised: February 2020 Ketamine Procedural Sedation for Children in The Emergency Department (Feb 2020) 15 Summary of recommendations 1. Ketamine sedation may be appropriate for a procedure that is painful, or frightening after all other options have been considered. 2. Ketamine should not be used for sedation (...) in the Emergency Department for children under the age of 1 year. Ketamine should be only be used by clinicians with significant relevant experience in the use of ketamine when performing procedural sedation in children aged between 2-5 years. 3. Ketamine sedation should take place in an area with full resuscitation facilities immediately available. 4. Safe sedation requires adequate senior medical and nursing cover in the Emergency Department when any sedation takes place. 5. Ketamine sedation requires
Dexamethasone Versus Ketamine in the Interscalene Block in Patients Undergoing Arthroscopic Shoulder Surgery: A Randomized Double-Blinded Study. Arthroscopic shoulder surgery (ASS) is often followed by severe pain. Interscalene brachial plexus block (ISB) was used to relieve such pain. The aim of the study was to compare the effect of adding either dexamethasone or ketamine to ISB on time to the fi rst request for analgesia.Sixty patients scheduled for ASS were enrolled in this study. Before (...) induction of general anaesthesia, patients were randomly allocated to two groups; in Group D, patients received ISB with bupivacaine 0.3%, 5 mL lidocaine 2% plus 8 mg dexamethasone. Whereas in Group K, patients received ISB with bupivacaine 0.3%, 5 mL lidocaine 2% plus 50 mg ketamine. Time to the fi rst administration of supplemental analgesic postoperative was our primary concern. Secondary outcomes included pain score, patient satisfaction, and side effects of either block or drugs. Student's t-test
Ketamine for Pharmacological Management of Aggression and Agitation in Pre-Hospital Settings: A Review of Comparative Clinical Effectiveness, Safety and Guidelines Ketamine for Pharmacological Management of Aggression and Agitation in Pre-Hospital Settings: A Review of Comparative Clinical Effectiveness, Safety and Guidelines | CADTH.ca Find the information you need Ketamine for Pharmacological Management of Aggression and Agitation in Pre-Hospital Settings: A Review of Comparative Clinical (...) Effectiveness, Safety and Guidelines Ketamine for Pharmacological Management of Aggression and Agitation in Pre-Hospital Settings: A Review of Comparative Clinical Effectiveness, Safety and Guidelines Last updated: May 13, 2019 Project Number: RC1118-000 Product Line: Research Type: Drug Report Type: Summary with Critical Appraisal Result type: Report Question What is the comparative evidence regarding safety of ketamine administration performed in pre-hospital settings versus by a physician
Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery Persistent postsurgical pain is common and affects quality of life. The hypothesis was that use of pregabalin and ketamine would prevent persistent pain after cardiac surgery.This randomized, double-blind, placebo-controlled trial was undertaken at two cardiac surgery centers in the United Kingdom. Adults without chronic pain and undergoing any elective cardiac surgery patients via sternotomy (...) were randomly assigned to receive either usual care, pregabalin (150 mg preoperatively and twice daily for 14 postoperative days) alone, or pregabalin in combination with a 48-h postoperative infusion of intravenous ketamine at 0.1 mg · kg · h. The primary endpoints were prevalence of clinically significant pain at 3 and 6 months after surgery, defined as a pain score on the numeric rating scale of 4 or higher (out of 10) after a functional assessment of three maximal coughs. The secondary outcomes
Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial Kidney stones are a fairly common problem that manifests itself as symptoms of acute abdominal and flank pains in patients presenting to emergency departments.The present study was conducted to compare the analgesic effect of intravenous fentanyl with that of intranasal ketamine in renal colic patients.One mg/kg of intranasal ketamine was administered (...) in the first group, and one μg/kg of intravenous fentanyl in the second group. The pain severity was measured in the patients in terms of a visual analogue scale (VAS) score at the beginning of the study and at minutes 5, 15 and 30, and the medication side-effects were evaluated and recorded.A total of 130 patients were ultimately assessed in two groups of 65. In the ketamine group, the mean severity of pain was 8.72 ± 1.52 at the beginning of the study (P < 0.001), 5.5 ± 2.97 at minute 5 (P < 0.001
Effects of Ketamine on Brain Activity During Emotional Processing: Differential Findings in Depressed Versus Healthy Control Participants. In the search for novel treatments for depression, ketamine has emerged as a unique agent with rapid antidepressant effects. Experimental tasks involving emotional processing can be used during functional magnetic resonance imaging scanning to investigate ketamine's effects on brain function in major depressive disorder (MDD). This study examined ketamine's (...) effects on functional magnetic resonance imaging activity during an emotional processing task.A total of 33 individuals with treatment-resistant MDD and 24 healthy control participants (HCs) took part in this double-blind, placebo-controlled crossover study. Participants received ketamine and placebo infusions 2 weeks apart, and functional magnetic resonance imaging scans were conducted at baseline and 2 days after each infusion. Blood oxygen level-dependent signal was measured during an emotional
Comparing the analgesic efficacy of morphine plus ketamine versus morphine plus placebo in patients with acute renal colic: A double-blinded randomized controlled trial Renal colic (RC) is a common cause for emergency department visits. This study was conducted to compare the analgesic efficacy of morphine plus ketamine (MK) versus morphine plus placebo (MP) in patients with acute renal colic.Using a single center, double-blind, two-arm, parallel-group, randomized controlled trial, 200 patients (...) were equally and randomly divided to receive 0.1 mg/kg morphine plus normal saline and 0.1 mg/kg morphine plus 0.2 mg/kg ketamine. The severity of renal colic was assessed by VAS at baseline, 20 and 40 min after drug injection. The number of adverse events also was recorded.Totally, 200 patients completed the study. Mean age of the patients was 35.60 ± 8.17 years. The patients were mostly men (68.5%). The severity of pain between the groups was not significantly different at baseline. Both groups
Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages e47–e49 Is Low-Dose Ketamine an Effective Alternative to Opioids for Acute Pain? x Jonathan M. Kirschner , MD (EBEM Commentator) , x Benton R. Hunter , MD (EBEM Commentator) Department (...) of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN DOI: | Publication History Published online: December 11, 2018 Expand all Collapse all Article Outline Take-Home Message In adult emergency department (ED) patients with acute pain, low-dose intravenous ketamine (0.3 to 0.5 mg/kg) may provide pain relief within 10 minutes that is similar to that of single-dose intravenous morphine (0.1 mg/kg). Methods Data Sources A medical librarian searched MEDLINE, EMBASE, Scopus, Cochrane
Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial Subanesthetic ketamine doses have been shown to have rapid yet transient antidepressant effects in patients with treatment-resistant depression, which may be prolonged by repeated administration. The purpose of this study was to evaluate the antidepressant effects of a single ketamine infusion, a series of repeated ketamine infusions, and prolongation of response (...) with maintenance infusions.Forty-one participants with treatment-resistant depression completed a single-site randomized double-blind crossover comparison of single infusions of ketamine and midazolam (an active placebo control). After relapse of depressive symptoms, participants received a course of six open-label ketamine infusions administered thrice weekly over 2 weeks. Responders, classified as those participants who had a ≥50% decrease in their scores on the Montgomery-Åsberg Depression Rating Scale
Subdissociative-dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain Subdissociative-dose ketamine (SDDK) is used to treat acute pain. We sought to determine if SDDK is effective in relieving acute exacerbations of chronic pain.This study was a randomized double-blind placebo-controlled trial conducted May 2017 to June 2018 at a public teaching hospital (ClinicalTrials.gov #NCT02920528). The primary endpoint was a 20-mm decrease on a 100-mm visual analog scale (VAS) at 60 (...) minutes. Power analysis using three groups (0.5 mg/kg ketamine, 0.25 mg/kg ketamine, or placebo infused over 20 minutes) estimated that 96 subjects were needed for 90% power. Inclusion criteria included age > 18 years, chronic pain > 3 months, and acute exacerbation (VAS ≥ 70 mm). Pain, agitation, and sedation were assessed by VAS at baseline and 20, 40, and 60 minutes after initiation of study drug. Telephone follow-up at 24 to 48 hours used a 10-point numeric rating scale for pain.A total of 106
Effects of low-dose ketamine infusion on remifentanil-induced acute opioid tolerance and the inflammatory response in patients undergoing orthognathic surgery Remifentanil is associated with acute opioid tolerance that can lead to increased postoperative consumption of opioid analgesics. The purpose of this study was to determine whether a low dose of ketamine prevents remifentanil-induced acute opioid tolerance and affects the neutrophil-lymphocyte ratio (NLR), a newly recognized biomarker (...) of inflammation.Forty patients undergoing orthognathic surgery were enrolled in this prospective, randomized, double-blind study and randomly assigned to intraoperative administration of one of the following anesthetic regimens: high-dose remifentanil (0.6 µg/kg/minute); low-dose remifentanil (0.2 µg/kg/minute); or high-dose remifentanil with ketamine (remifentanil 0.6 µg/kg/minute with 0.5 mg/kg ketamine just after induction followed by an intraoperative infusion of ketamine 5 µg/kg/minute until wound closure
Effect of Intranasal Ketamine vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The PRIME Randomized Clinical Trial Timely analgesia is critical for children with injuries presenting to the emergency department, yet pain control efforts are often inadequate. Intranasal administration of pain medications provides rapid analgesia with minimal discomfort. Opioids are historically used for significant pain from traumatic injuries but have concerning adverse effects. Intranasal (...) ketamine may provide an effective alternative.To determine whether intranasal ketamine is noninferior to intranasal fentanyl for pain reduction in children presenting with acute extremity injuries.The Pain Reduction With Intranasal Medications for Extremity Injuries (PRIME) trial was a double-blind, randomized, active-control, noninferiority trial in a pediatric, tertiary, level 1 trauma center. Participants were children aged 8 to 17 years presenting to the emergency department with moderate to severe
Premedication With Midazolam or Haloperidol to Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double-Blind Clinical Trial We evaluate the effect of midazolam and haloperidol premedication for reducing ketamine-induced recovery agitation in adult patients undergoing procedural sedation. We also compare physician satisfaction and recovery time.We randomized emergency department patients older than 18 years who needed procedural sedation to receive (...) 1 of the following 3 interventions in double-blind fashion 5 minutes before receiving intravenous ketamine at 1 mg/kg: intravenous distilled water, intravenous midazolam at 0.05 mg/kg, or intravenous haloperidol at 5 mg. Our main study outcomes were recovery agitation as assessed by the maximum observed Pittsburgh Agitation Scale score and by the Richmond Agitation-Sedation Scale score at 5, 15, and 30 minutes after ketamine administration. Our secondary outcomes were clinician satisfaction