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Latest & greatest articles for ketamine
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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
Ketamine for depression: where do we go from here? Ketamine for depression: where do we go from here? Ketamine for depression: where do we go from here? aan het Rot M, Zarate CA, Charney DS, Mathew SJ CRD summary The review concluded that ketamine seemed a reasonable treatment option for most patients with treatment resistant depression when administered by trained clinicians in appropriate settings. This was a poorly reported review that was at risk of various forms of bias. The synthesis (...) was limited which suggests that definitive conclusions cannot be drawn, and the authors’ conclusions cannot be considered reliable. Authors' objectives To evaluate the antidepressant effects of ketamine for patients with major depressive episodes. Searching PubMed was searched to January 2012 for relevant articles; search terms were reported. ClinicalTrials.gov was also searched for studies that were unpublished, currently recruiting participants or not yet enrolling. Additional relevant studies cited
Ketamine for mood disorders Ketamine for mood disorders Ketamine for mood disorders Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation Ketamine for mood disorders. Lansdale: HAYES, Inc.. Directory Publication. 2012 Authors' conclusions Intravenous injection of ketamine hydrochloride is intended to reduce symptoms of depression in patients with treatment-resistant (...) depression. Final publication URL The report may be purchased from: Indexing Status Subject indexing assigned by CRD MeSH Humans; Ketamine; Mood Disorders Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence HAYES, Inc., 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218 Email: firstname.lastname@example.org AccessionNumber 32013000192 Date abstract record published 25/03
Is ketamine a viable induction agent for the trauma patient with potential brain injury. BestBets: Is ketamine a viable induction agent for the trauma patient with potential brain injury. Is ketamine a viable induction agent for the trauma patient with potential brain injury. Report By: Sian Hughes - CT3 Emergency Medicine Search checked by Dan Horner and Janos Baombe - Research Fellow / Senior Emergency Trainee Institution: Morriston Hospital Swansea NHS Trust Original institution: Central (...) Manchester University Hospitals NHS Foundation Trust Current web editor: Stewart Teece - Clinical Research Fellow Date Submitted: 30th April 2011 Date Completed: 30th November 2011 Last Modified: 30th November 2011 Status: Green (complete) Three Part Question In [adults with head injury necessitating emergency intubation] does [the use of ketamine as an induction agent, compared to any other standard agent] lead to [increased morbidity/mortality]? Clinical Scenario A 26 year-old male is brought
A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation We compare the frequency of respiratory depression during emergency department procedural sedation with ketamine plus propofol versus propofol alone. Secondary outcomes are provider satisfaction, sedation quality, and total propofol dose.In this randomized, double-blind, placebo-controlled trial, healthy children and adults undergoing procedural sedation were pretreated (...) with intravenous fentanyl and then randomized to receive either intravenous ketamine 0.5 mg/kg or placebo. In both groups, this procedure was immediately followed by intravenous propofol 1 mg/kg, with repeated doses of 0.5 mg/kg as needed to achieve and maintain sedation. Respiratory depression was defined according to any of 5 predefined markers. Provider satisfaction was scored on a 5-point scale, sedation quality with the Colorado Behavioral Numerical Pain Scale, and propofol dose according to the total
Brief report: the effect of suggestion on unpleasant dreams induced by ketamine administration The use of ketamine may be associated with the recall of unpleasant dreams after sedation. We hypothesized that a positive suggestion before sedation could reduce the incidence of ketamine-induced unpleasant dreams. To test this hypothesis, we randomized 100 patients receiving sedation with ketamine for their procedure into 2 groups with 1 group having an anesthesiologist provide a mood-elevating (...) suggestion to the patient before ketamine administration (suggestion group), whereas in the control group no suggestion was provided. Patients were provided with a pleasantness/unpleasantness scale to rate "the overall mood of the dream" as very unpleasant (grade 1), quite unpleasant (grade 2), neither or mixed (grade 3), quite pleasant (grade 4), and very pleasant (grade 5). In those patients who lost consciousness, the frequencies of grades 1, 2, 3, 4, and 5 were 0%, 0%, 46%, 24%, and 30
Intravenous ketamine for chronic nonmalignant pain Intravenous ketamine for chronic nonmalignant pain Intravenous ketamine for chronic nonmalignant pain Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation Intravenous ketamine for chronic nonmalignant pain. Lansdale: HAYES, Inc.. Healthcare Technology Brief Publication. 2011 Authors' objectives Chronic pain, or pain (...) or a multidisciplinary plan including physical therapy, drug therapy, sympathetic nerve block, spinal cord stimulation, and intrathecal drug pumps to deliver opioids and local anesthetic agents via the spinal cord. Final publication URL The report may be purchased from: Indexing Status Subject indexing assigned by CRD MeSH Infusions, Intravenous; Ketamine; Pain Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence HAYES
Ketamine, but not priming, improves intubating conditions during a propofol-rocuronium induction Both ketamine and priming may shorten the onset time of rocuronium. This study investigates the effects of ketamine and priming as components of a propofol induction on intubating conditions and onset of neuromuscular block.This prospective randomized double-blind study was performed in 120 American Society of Anesthesiologists (ASA) I-II patients who were assigned to one of four groups of 30 (...) patients each: control, priming, ketamine, and ketamine-priming. Ketamine 0.5 mg x kg(-1) or saline was given before priming and induction. Rocuronium 0.06 mg x kg(-1) or saline was injected 2 min before propofol 2.5 mg x kg(-1). This was followed by rocuronium 0.6 mg x kg(-1) or by rocuronium 0.54 mg x kg(-1) if priming was given. Intubation was performed one minute later. Intubating conditions were graded as excellent, good, or poor. Heart rate, noninvasive blood pressure, and train-of-four (TOF
Preemptive analgesic effect of ketamine in patients undergoing elective cesarean section In this study, the preemptive effect of a small dose of ketamine on postoperative wound pain and morphine consumption in patients undergoing elective cesarean section was evaluated.In a randomized, double-blind clinical trial, 60 women with American Society of Anesthesiologists class I and II identification undergoing elective cesarean section were enrolled. In the case group, the patients received 0.5 mg (...) /kg ketamine, and in the control group, they received isotonic saline, 5 minutes before the induction of anesthesia. Anesthesia was induced with 4 mg/kg thiopental followed by 1.5 mg/kg succinylcholine. A further neuromuscular block was achieved by using 0.2 mg/kg of atracurium. Anesthesia was maintained with nitrous oxide 50% and halothane in oxygen. The lungs were mechanically ventilated. After fetus delivery, fentanyl (2 microg/kg) and morphine (0.15 mg/kg) were given intravenously
The early and delayed analgesic effects of ketamine after total hip arthroplasty: a prospective, randomized, controlled, double-blind study Ketamine has been shown to have a morphine-sparing effect soon after surgery. Nevertheless, whether this effect still exists after being combined with nonsteroidal antiinflammatory drugs and acetaminophen, and whether ketamine can decrease chronic pain after nononcologic surgery remain unclear. Thus, we designed a study to assess ketamine's effect on acute (...) and chronic postoperative pain when combined with multimodal analgesia after total hip arthroplasty (THA).Patients scheduled for primary nononcologic THA using standardized general anesthesia were randomized. They received IV ketamine before incision (0.5 mg/kg), and a 24-h infusion (2 microg x kg(-1) x min(-1)) or a similar blinded saline bolus and infusion. Postoperative analgesia included IV acetaminophen, ketoprofen, plus morphine/droperidol patient-controlled analgesia for 48 h. Data pertaining
Ketamine produces effective and long-term pain relief in patients with Complex Regional Pain Syndrome Type 1 Complex Regional Pain Syndrome Type 1 (CRPS-1) responds poorly to standard pain treatment. We evaluated if the N-methyl-D-aspartate receptor antagonist S(+)-ketamine improves pain in CRPS-1 patients. Sixty CRPS-1 patients (48 females) with severe pain participated in a double-blind randomized placebo-controlled parallel-group trial. Patients were given a 4.2-day intravenous infusion (...) of low-dose ketamine (n=30) or placebo (n=30) using an individualized stepwise tailoring of dosage based on effect (pain relief) and side effects (nausea/vomiting/psychomimetic effects). The primary outcome of the study was the pain score (numerical rating score: 0-10) during the 12-week study period. The median (range) disease duration of the patients was 7.4 (0.1-31.9) years. At the end of infusion, the ketamine dose was 22.2+/-2.0 mg/h/70 kg. Pain scores over the 12-week study period in patients
Postoperative analgesia and early rehabilitation after total knee replacement: a comparison of continuous low-dose intravenous ketamine versus nefopam The effects of nefopam and ketamine on pain control and rehabilitation after total knee replacement were compared in a prospective, double blinded study. Seventy-five patients were randomly assigned to receive a 0.2mg kg(-1) bolus of nefopam or ketamine, followed by a 120microg kg(-1) h(-1) continuous infusion until the end of surgery (...) , and 60microg kg(-1) h(-1) until the second postoperative day, or an equal volume of saline considered as placebo. Pain scores measured on a visual analog scale at rest and on mobilization, and patient-controlled intravenous morphine consumption, were assessed during 48h. We measured the maximal knee flexion on the third postoperative day, and the delay to obtain a 90 degrees flexion. Ketamine and nefopam reduced morphine consumption (p<0.0001). Pain scores, were lower at rest and on mobilization
Morphine with adjuvant ketamine vs. Higher doses of morphine alone for immediate post-thoracotomy analgesia Thoracotomy is associated with severe pain. We hypothesized that the concomitant use of a subanesthetic dose of ketamine plus a two-third-standard morphine dose might provide more effective analgesia with fewer side effects than a standard morphine dose for early pain control.We conducted a 6-month randomized, double-blind study in patients undergoing thoracotomy for minimally invasive (...) direct coronary artery bypass or for lung tumor resection. After extubation, when objectively awake (>or= 5/10 visual analogue scale [VAS]) and complaining of pain (>or= 5/10 VAS), patients were connected to patient-controlled IV analgesia delivering 1.5 mg of morphine plus saline solution (MO) or 1.0 mg of morphine plus a 5-mg ketamine bolus (MK), with a 7-min lockout time. Rescue IM diclofenac, 75 mg, was available. Follow-up lasted 4 h.Forty-one patients completed the study. MO patients (n = 20
Ketamine and lornoxicam for preventing a fentanyl-induced increase in postoperative morphine requirement N-methyl-D-aspartate receptor antagonists and nonsteroidal anti-inflammatory drugs are believed to prevent opioid-induced hyperalgesia and/or acute opioid tolerance, which could cause an increase in postoperative opioid requirement. In this randomized, double-blind, placebo-controlled study, we investigated whether co-administration of ketamine or lornoxicam and fentanyl could prevent (...) the increase of postoperative morphine requirement induced by fentanyl alone.Ninety females undergoing total abdominal hysterectomy with spinal anesthesia were randomly assigned to six groups consisting of placebo (normal saline, C), fentanyl (three bolus of 1 microg x kg(-1), F), ketamine (infusion of 15 microg x kg(-1) x min(-1), K), ketamine and fentanyl (infusion of 15 microg x kg(-1) x min(-1) ketamine plus three bolus of 1 microg x kg(-1) fentanyl, FK), lornoxicam (one bolus of 8 mg, L
Pharmacological Dental Anxiety Management with Ketamine and Midazolam in Uncooperative Children UTCAT447, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Pharmacological Dental Anxiety Management with Ketamine and Midazolam in Uncooperative Children Clinical Question In young uncooperative children, will ketamine be more effective than midazolam in reducing dental anxiety? Clinical Bottom Line The benzodiazepine (...) midazolam was more effective than ketamine in reducing dental anxiety in young uncooperative children. (See Comments on the CAT below) 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) Damle/2008 Uncooperative children 2-6 years of age. Randomized Controlled Trial Key results Dental anxiety was lower with the use of ketamine than with midazolam. Heart rate and respiratory rate were marginally higher