Addition Of Low-dose Ketamine Research Articles

Compare the Effect of Addition of Low Dose Ketamine to Tramadol for the Prevention of Shivering Under Spinal Anesthesia

Objective: To see if adding a mild dosage of ketamine to tramadol can help avoid shivering when under spinal anaesthesia. Study Design: Randomized study Place and Duration: The study was conducted at the department of Anesthesia, Sindh Government Liyari General Hospital Karachi and Shiekh Khalifa Bin Zayed Hospital, Quetta for the duration of six-months from December 2020 to May 2021. Methods: There were one hundred and seventy patients of both genders undergoing inguinal hernia were included in this study. Informed permission was obtained before to calculating demographic information such as age, sex and BMI. Patients were divided equally into two groups. Group A had 85 patients and received low dose ketamine 0.25 mg/kg (K) into tramadol and group B had 85 patients and received tramadol 0.5 mg/kg (T) alone. Post-treatment effectiveness among both groups was compared in terms of shivering control. We used SPSS 19.0 version to analyze complete data. Results: In group I the mean age of the patients was 33.9±9.76 years and mean age in group II was 31.5±3.23 years. There were 55 (64.7%) males and 30 (35.3%) females in group I while in group II 65 (70.6%) were males and 30 (29.4%) females. HTN and diabetes mellitus were the most common comorbidities found among both groups. 50 (58.2%) patients in group I had ASA class II and in group II 54 (63.2%) had ASA class II. We found that low dose ketamine to tramadol was effective in reduction of shivering in 33 (38.9%) as compared to tramadol alone shivering found in 41 (48.2%) cases. Conclusion: We concluded in this study that low dose ketamine into tramadol under spinal anesthesia is an effective and useful in terms of reduction in shivering as compared to tramadol alone in patients undergoing surgery. Keywords: Spinal Anesthesia, Ketamine, Tramadol, Shivering

Low-dose ketamine as an adjuvant for pain control in a cancer patient: a case report

Cancer patients often suffer from pain related problems such as under-treatment of pain, ineffective and persistent opioid administration as well as adverse opioid use outcomes. There is a growing need for non-opioid analgesic alternatives for patients undergoing treatment for obstinate pain. Ketamine is a fast-acting N-methyl-D-aspartate (NMDA) receptor antagonist that has been emerging as an effective medication for pain alleviation. While protocols have been established for the use of Low-Dose Ketamine (LDK) for post-operative pain, there is growing evidence for using LDK as a clinical alternative to opioids in a palliative care setting. This case study involves monitoring the efficacy of LDK treatment in combination with opioid analgesics in a cancer patient in a hospital setting. This is a very selected case of a patient with Metastatic Prostate Cancer (Gleason 9 Adenocarcinoma) where LDK was shown to be efficacious at reducing pain when opioids and standard pain medications were not satisfactory. While the study involved using a relatively novel pharmacological protocol and close patient monitoring, the patient reported a sustained reduction in pain level based on the Numerical Rating Scale for months after the termination of LDK infusions. Moreover, the treatment also resulted in a reduction of total opioid usage after the addition of LDK. Although additional research is needed to ascertain optimal dosing schedules and route of Ketamine, given these promising findings, Ketamine may be a useful option for improving the treatment of refractory pain in patients with cancer and a good tool in palliative medicine for treating neoplastic pain.

Oral premedication in children: Comparison of combination of midazolam-ketamine and oral midazolam- A Randomised trial

Introduction: Premedication with sedative drugs is often used in paediatric practice as one of the modalities to reduce preoperative anxiety in children undergoing surgery. It reduces both patient and parental anxiety and improves overall satisfaction. Also, provides anterograde amnesia and reduces postoperative behavioral changes and adverse outcomes in children. The ideal premedication in children should be readily acceptable and should have speedy and reliable onset with negligible side effects. Materials and Methods: After obtaining institutional medical ethics committee approval, sixty ASA physical status I or II children, aged 1-8 years scheduled for elective surgery were randomly allocated into one of the two groups. Group M (n=30): received preservative free oral midazolam 0.5mg/kg (1ml=5mg) + acetaminophen based syrup (5ml=120mg) upto maximum value of 0.4ml/kg. Group MK (n=30): received preservative free oral midazolam 0.25 mg/kg (1ml=5mg)with 3mg/kg oral ketamine(1ml=50mg) + acetaminophen based syrup (5ml=120mg) upto maximum value of 0.4ml/kg. Results: Combination of midazolam0.25mg/kg and ketamine3mg/kg provided faster onset and higher degree of sedation, comparable incidence of satisfactory parental separation and mask acceptance without any added side effects in comparison to midazolam 0.5mg/kg. Conclusion: Addition of low dose ketamine to midazolam as a premedication provides adequate sedation. Keywords: Premedication, Midazolam, Ketamine, Pediatric patients, Sedation

A comparison of dexmedetomidine plus ketamine combination with dexmedetomidine alone for awake fiberoptic nasotracheal intubation: A randomized controlled study.

Background and Aims:We designed a study to compare the effectiveness of dexmedetomidine plus ketamine combination with dexmedetomidine alone in search of an ideal sedation regime, which would achieve better intubating conditions, hemodynamic stability, and sedation for awake fiberoptic nasotracheal intubation.Materials and Methods:A total of 60 adult patients of age group 18-60 years with American Society of Anesthesiologists I and II posted for elective surgery under general anesthesia were randomly divided into two groups of 30 each in this prospective randomized controlled double-blinded study. Groups I and II patients received a bolus dose of dexmedetomidine at 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. Upon completion of the dexmedetomidine bolus, Group I patients received 15 mg of ketamine and an infusion of ketamine at 20 mg/h followed by awake fiberoptic nasotracheal intubation, while Group II patients upon completion of dexmedetomidine bolus received plain normal saline instead of ketamine. Hemodynamic variables like heart rate (HR) and mean arterial pressure (MAP), oxygen saturation, electrocardiogram changes, sedation score (modified Observer assessment of alertness/sedation score), intubation score (vocal cord movement and coughing), grimace score, time taken for intubation, amount of lignocaine used were noted during the course of study. Patient satisfaction score and level of recall were assessed during the postoperative visit the next day.Results:Group I patients maintained a stable HR and MAP (<10% fall when compared with the baseline value). Sedation score (3.47 vs. 3.93) and patient satisfaction score were better in Group I patients. There was no significant difference in intubation scores, grimace scores, oxygen saturation and level of recall when compared between the two groups (P > 0.05).Conclusion:The use of dexmedetomidine plus ketamine combination in awake fiberoptic nasotracheal intubation provided better hemodynamic stability and sedation than dexmedetomidine alone.

Comparison of propofol‐fentanyl with propofol‐fentanyl‐ketamine combination in pediatric patients undergoing interventional radiology procedures

With an increase in the frequency of interventional radiology procedures in pediatrics, there has been a corresponding increase in demand for procedural sedation to facilitate them. The purpose of our study was to compare the frequency of adverse effects, sedation level, patient recovery characteristics in pediatric patients receiving intravenous propofol fentanyl combination with or without ketamine for interventional radiology procedures. Our main hypothesis was that the addition of ketamine would decrease propofol/fentanyl associated desaturation. Sixty consenting American Society of Anesthesia physical status I-III pediatric patients undergoing interventional radiology procedures under sedation were studied according to a randomized, double-blinded, institutional review board approved protocol. Group 1 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + ketamine 0.5 mg.kg(-1), and group 2 received propofol 0.5 mg.kg(-1) + fentanyl 1 microg.kg(-1) + same volume of %0.9 NaCl intravenously. While apnea was not observed in any of the groups, there were three cases (10%) in group 1, and nine cases (30%) in group 2 with oxygen desaturation (P = 0.052). In group 1, 12 (40%) patients and, in group 2, 21 (70%) patients required supplemental propofol during the procedure (P = 0.021). There was no evidence for difference between groups in terms of other side effects except nystagmus. In conclusion, addition of low dose ketamine to propofol-fentanyl combination decreased the risk of desaturation and it also decreased the need for supplemental propofol dosage in pediatric patients at interventional radiology procedures.

Comparison of propofol with propofol–ketamine combination in pediatric patients undergoing auditory brainstem response testing

The aim of our study was to compare propofol with propofol-ketamine combination for sedation and also to compare related complications in children undergoing auditory brainstem response (ABR) testing. Sixty ASA I-II patients aged between 1 and 13 years of age were sedated for ABR testing. Propofol 1.5mg/kg was used in group P (n=30), and ketamine 0.5 mg/kg+propofol 1.5 mg/kg, i.v., in group PK (n=30). Sedation levels of patients were maintained between scores 3 and 4 according to Ramsey sedation scores; when necessary, half of the starting drug dosage was administered for the maintenance of sedation. Side effects which occurred during or within the first 24h of the procedure were assessed. Additional dosage was needed for 21 cases in group P and eight cases in group PK (p=0.002). While oxygen desaturation and apnea were not observed in any of the patients in group PK, there were four patients (11.4%) with oxygen desaturation, and six (17.1%) with apnea in group P (p<0.05). In pediatric cases where ABR testing was applied, addition of low dose ketamine to propofol avoided the risk of respiratory depression due to propofol and lowered the need for additional dose of propofol. Therefore, the co-administration of propofol and ketamine appears to be a safe and useful technique for ABR testing.

Addition of Low-Dose Ketamine to General Anesthesia Does Not Improve Cardiovascular Response During Conventional Abdominal Surgery

Addition of Low-Dose Ketamine to General Anesthesia Does Not Improve Cardiovascular Response During Conventional Abdominal Surgery

Addition of Low-Dose Ketamine to General Anesthesia Does Not Improve Cardiovascular Response During Conventional Abdominal Surgery

Addition of Low-Dose Ketamine to General Anesthesia Does Not Improve Cardiovascular Response During Conventional Abdominal Surgery

Addition of Low-Dose Ketamine to General Anesthesia Does Not Improve Cardiovascular Response During Conventional Abdominal Surgery

Addition of Low-Dose Ketamine to General Anesthesia Does Not Improve Cardiovascular Response During Conventional Abdominal Surgery