Effect Of Intravenous Ketamine Research Articles

Effects of Intravenous Ketamine, Butorphanol and Fentanyl for the Management of Intraoperative Shivering under Spinal Anaesthesia- A Randomised Clinical Trial

Introduction: Neuraxial block can cause intraoperative shivering. Though, so many drugs have been studied for treatment of shivering, none has been found ideal. N-methyl-Daspartate (NMDA) antagonist like ketamine, k-opioid receptor agonist butorphanol and µ receptors agonist fentanyl have shown antishivering effect but each one has its own demerits. Aim: To examine the efficacy of ketamine, butorphanol, and fentanyl in suppressing shivering under spinal anaesthesia in elective lower abdomen and lower limb surgery. Materials and Methods: The double-blind, randomised trial was conducted between June 2011 to September 2013. A total of 90 patients, posted for surgery under spinal anaesthesia, were randomly allocated into three groups of 30 each. After giving spinal anaesthesia, patients who developed shivering (grade 3 or more), lasting for more than 3 minutes, the study drugs were administered. Patients in Group I received ketamine (0.5 mg/ kg), Group II received butorphanol (0.02 mg/kg) and Group III received fentanyl (1 µg/kg), intravenously. Time taken to control shivering, sedation and any side-effects nausea and vomiting were assessed. The dose was given over 60 seconds and the time duration for the complete disappearance of shivering was noted (after the drug administration) at 2 min, 5 min, 10 min, 20 min, and 30 min. The sedation score was determined after 10 minutes of administering drug. Comparison of the observations among different groups was done and statistically analysed using Fisher-exact test, ANOVA, Chi-square test. Results: Shivering control time was much shorter in Group II (3.6±1.20 min) than in Group I (3.867±1.676 min), but significantly longer in Group III (5.467±2.047 min). Mean age of Group I, II and III was 37.6, 34, 36.7 respectively. Reappearance of shivering was substantially more common in Group III (20%) than in Groups-I (0%) and II (0%). Conclusion: Ketamine, buterophanol and fentanyl are equally effective for controlling shivering at 10 minutes after the administrating of study drugs but butorphanol is faster acting, followed by ketamine and then fentanyl to control of shivering.

The Effect of Intravenous Ketamine on Suicidal Ideation in Depressed Patients: A Randomized Clinical Trial

Background: Major depressive disorder (MDD) generally occurs together with depression in patients with no history of manic, mixed, or hypomanic episodes. The suicidal ideation in MDD patients is very common and can potentially be considered an emergency circumstance in many cases. Among the developed drugs and medicines, ketamine (KET) is a potential option to treat patients with MDD. This study aims at investigating the effect of KET on the treatment of suicidal ideation and the reduction of the intensity of symptoms in patients suffering from MDD. Materials and Methods: This randomized double-blind clinical trial was performed on 30 patients who suffered from MDD and had suicidal ideation at Ibn Sina Hospital, Bandar Abbas, Iran, during 2016-2017. The patients were divided into two groups: the KET group which received 0.5 mg/kg of intravenous (IV) KET diluted in 500 mL of normal saline over 30 minutes and the control group which received 500 mL of normal saline without KET over 30 minutes. Results: According to the statistical analysis, 24 hours after the intervention, suicidal ideation score reached 2.53 and 20.6 in the KET and control groups, respectively. In fact, KET caused a significant reduction in the score of the suicidal ideation (SSI) (SSI<4) in comparison with the control group (P<0.001). Conclusion: It was observed that KET can play a key role in the treatment of depression disorders, especially severe and life-threatening forms that require immediate intervention, such as the use of electroconvulsive therapy.

Effect of Intravenous Ketamine on Hypocranial Pressure Symptoms in Patients with Spinal Anesthetic Cesarean Sections: A Systematic Review and Meta-Analysis.

Background: Pregnant women are more likely to suffer post-puncture symptoms such as headaches and nausea due to the outflow of cerebrospinal fluid after spinal anesthesia. Because ketamine has the effect of raising intracranial pressure, it may be able to improve the symptoms of perioperative hypocranial pressure and effectively prevent the occurrence of hypocranial pressure-related side effects. Method: Keywords such as ketamine, cesarean section, and spinal anesthesia were searched in databases including Medline, Embase, Web of Science, and Cochrane from 1976 to 2021. Thirteen randomized controlled trials were selected for the meta-analysis. Results: A total of 12 randomized trials involving 2099 participants fulfilled the inclusion criteria. There was no significant association between ketamine and the risk of headaches compared to the placebo (RR = 1.12; 95% CI: 0.53, 2.35; p = 0.77; I² = 62%). There was no significant association between ketamine and nausea compared to the placebo (RR = 0.66; 95% CI: 0.40, 1.09; p = 0.10; I² = 57%). No significant associations between ketamine or the placebo and vomiting were found (RR = 0.94; 95% CI: 0.53, 1.67; p = 0.83; I² = 72%). Conclusion: Intravenous ketamine does not improve the symptoms caused by low intracranial pressure after spinal anesthesia in patients undergoing cesarean section.

The Effect of Intravenous Ketamine After Spinal Anesthesia on the Duration of Postoperative Analgesia and Analgesic Requirement

Objective: To evaluate the impact of ketamine following spinal anesthesia on the duration of postoperative analgesia and the need for analgesics. Methods: This was a prospective, randomized, double-blinded placebo-controlled study done over a period of two years. A total of 60 participants undergoing elective surgeries under spinal anesthesia were randomized into two groups. After 10 min of spinal anesthesia and achieving the required level of sensory and motor blockade, both groups were given Inj. Midazolam 1 mg intravenously, followed by Inj. Ketamine 0.25 mg/kg, volume made up to 10 mL with normal saline, given intravenously for Group K and Inj. Normal Saline 10 mL was given intravenously for Group N. Hemodynamic monitoring was done intraoperatively, and the postoperative visual analog score (VAS), sedation score, the mean time for the first rescue analgesia, and the total dose of postoperative analgesic required in 24 h were tabulated. Results: There was no statistical difference between the two groups in terms of age, weight, ASA grade, and duration of surgery. In Group K, the VAS scores were significantly lower and patients were comfortable when compared to Group N ( P value <.01). The mean time to first rescue analgesia was longer in Group K (6.4 ± 1.69 h) when compared to Group N (2.9 ± 1.01 h), and the total dose of postoperative analgesia (Tramadol) required in 24 h was also significantly less in Group K (143.33 ± 56.83 mg) when compared to Group N (236 ± 49.01 mg). Changes in hemodynamic parameters (heart rate and mean arterial pressure (MAP)) were statistically and clinically not significant in both the intraoperative and postoperative periods between the groups. Conclusion: Patients in Group K were more comfortable, had a longer duration of postoperative analgesia, and required less dose of rescue analgesia in the postoperative period. Ketamine is a safe drug that is readily available, and it decreases the use of opioids and opioid-related side effects. Therefore, ketamine can serve effectively as an adjunctive analgesic drug.

Evaluating the analgesic and sedative effects of intravenous ketamine versus morphine administration on relieving long/short bone-fracture pain in the upper/ lower limbs; a phase II clinical trial

Introduction: The importance of pain control in patients with limb trauma admitted to emergency departments as well as its complications is among the main concerns in post-emergency care, which contributes to the accelerated improvement of patients’ conditions in a significant manner. Objectives: The present study was to evaluate the analgesic and sedative effects of intravenous (IV) ketamine versus morphine administration on relieving long/short bone-fracture pain in the upper/lower limbs. Patients and Methods: The present study is as a double-blind randomized clinical trial. For this purpose, the effect of ketamine and morphine were initially examined using IV ketamine and morphine administration, respectively, at the doses of 0.4 and 0.1 mg/kg/IV/10 min in patients, aged 18-65 years with limb trauma, and admitted to hospital emergency departments. Afterward, the duration of the analgesic effect, the amount of pain relief, according to the visual analog scale (VAS) outcomes, and the complications for each drug, including apnea, bradycardia, tachycardia, altered level of consciousness, nausea, vomiting, hypertension/hypotension, seizures and disturbed sleep were compared, and then the preferred method was introduced. Results: In this study, 120 patients in total, including 60 cases receiving ketamine and 60 individuals receiving morphine, were recruited. The participants’ age range was between 19 -70 years. The patients’ mean age was 47.04±12.57 years of whom 89 patients (74.2%) were male. The study results indicated that the potency of the low-dose ketamine infusion in relieving pain in patients was comparable to that of morphine. Conclusion: It was concluded that ketamine could be administered as an alternative to IV morphine to reduce long/short bone-fracture pain in the upper/lower limbs. Trial Registration: The trial protocol was authorized by the Iranian Registry of Clinical Trials, (identifier: IRCT20170716035105N3; https://en.irct.ir/trial/26628, ethical code: IR.AJUMS.REC.1396.248).

Effect of intravenous ketamine on sleep, cognition and anxiety in patients with treatment-resistant depression

Effect of intravenous ketamine on sleep, cognition and anxiety in patients with treatment-resistant depression

Comparison of the effect of intravenous ketamine and midazolam as a premedication in children undergoing cochlear implantation at the time of separation from parents

Background and aim: Preoperative anxiety and fear of separation from parents are some of the most important preoperative problems for children with deaf muteness. Here, the effect of intravenous administration of ketamine and midazolam was compared on sedation in children who candidates for choral cochlear implantation at the time of separation from parents. Patients and methods: This double-blind, prospective clinical study was performed on 74 children with deaf-muteness before cochlear implantation. Patients were randomly divided into two groups, midazolam (0.1 mg /kg) and ketamine (1 mg/kg). The sedation anxiety score scale (SASS) form was filled in to assess the anxiety and sedation status for each child. The children's relaxation score from recovery was assessed by the PACU sedation score scale (PACUSSS). Results: The average of the children's anxiety score after the injection of both drugs during the separation from their parents was 3, and there was no significant difference in the mean of SASS between the two groups (p>0.05). The mean PACU sedation score scale in both ketamine and midazolam groups was 1.08 ± 0.89 and 1.32 ± 1.01, respectively (p = 0.27). The mean of extubation and recovery times in the ketamine group were 10.44 ± 4.47 and 30.27 ± 6.87, respectively, while the mean extubation and recovery times in the midazolam group were 11.83 ± 3.33 and 29.81 ± 6.31 minutes, respectively. Conclusion: Both ketamine and midazolam caused equal sedation scores in children with deaf muteness at the time of separating from their parents.

The effect of intravenous ketamine on cognitive functions in adults with treatment-resistant major depressive or bipolar disorders: Results from the Canadian rapid treatment center of excellence (CRTCE)

Ketamine may exert pro-cognitive effects on select measures of cognition in adults with mood disorders. We evaluated the effectiveness of intravenous (IV) ketamine on cognition in 68 adult outpatients with treatment-resistant depression (TRD) at the Canadian Rapid Treatment Center of Excellence between July 3, 2018 and April 16, 2020 (NCT04209296). Eligibility criteria for the present retrospective study included: primary diagnosis of major depressive or bipolar disorder; currently depressed; and insufficient response to two or more prior treatments. Participants received four infusions of ketamine hydrochloride (0.5-0.75 mg/kg) over 1-2 weeks. We assessed objective and subjective measures of cognition before and after two infusions, i.e., Digit Symbol Substitution Test (DSST), Trail Making Test-B (TMT-B), Patient Deficits Questionnaire, 5-item (PDQ-5-D). Ketamine significantly improved DSST (effect size [ES]=0.60), TMT-B (ES=0.84), as well as PDQ-5-D scores (ES=0.63), indicative of a moderate-to-large effect size. Improvements in DSST and PDQ-5-D with ketamine were mediated by reductions in depressive symptoms, whereas improvements in TMT-B were independent of changes in depressive symptoms. Our results support the independent, rapid-onset, pro-cognitive effects with IV ketamine in adults with TRD. Larger, randomized, controlled trials with ketamine wherein cognition is the primary outcome measure in mood and non-mood disorder samples are warranted.

Effectiveness of intravenous ketamine in mood disorder patients with a history of neurostimulation

Patients unsuccessfully treated by neurostimulation may represent a highly intractable subgroup of depression. While the efficacy of intravenous (IV) ketamine has been established in patients with treatment-resistant depression (TRD), there is an interest to evaluate its effectiveness in a subpopulation with a history of neurostimulation. This retrospective, posthoc analysis compared the effects of four infusions of IV ketamine in 135 (x̄ = 44 ± 15.4 years of age) neurostimulation-naïve patients to 103 (x̄ = 47 ± 13.9 years of age) patients with a history of neurostimulation. The primary outcome evaluated changes in depression severity, measured by the Quick Inventory for Depression Symptomatology-Self Report 16-Item (QIDS-SR16). Secondary outcomes evaluated suicidal ideation (SI), anxiety severity, measured by the Generalized Anxiety Disorder 7-Item (GAD-7), and consummatory anhedonia, measured by the Snaith-Hamilton Pleasure Scale (SHAPS). Following four infusions, both cohorts reported a significant reduction in QIDS-SR16 Total Score (F (4, 648) = 73.4, P < .001), SI (F (4, 642) = 28.6, P < .001), GAD-7 (F (2, 265) = 53.8, P < .001), and SHAPS (F (2, 302) = 45.9, P < .001). No between-group differences emerged. Overall, the neurostimulation-naïve group had a mean reduction in QIDS-SR16 Total Score of 6.4 (standard deviation [SD] = 5.3), whereas the history of neurostimulation patients reported a 4.3 (SD = 5.3) point reduction. IV ketamine was effective in reducing symptoms of depression, SI, anxiety, and anhedonia in both cohorts in this large, well-characterized community-based sample of adults with TRD.

The effectiveness of intravenous ketamine in adults with treatment-resistant major depressive disorder and bipolar disorder presenting with prominent anxiety: Results from the Canadian Rapid Treatment Center of Excellence.

Individuals meeting criteria for treatment-resistant depression (TRD) are differentially affected by high levels of anxiety symptoms. There is a need to identify the efficacy of novel rapid-onset treatments in adults with mood disorders and comorbid anxious-distress. This study included patients with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD) who were receiving intravenous (IV) ketamine treatment at a community-based clinic.Anxious-distress was proxied using items from the Quick Inventory of Depressive Symptomatology-Self Report 16-item (QIDS-SR16) and Generalized Anxiety Disorder 7-item (GAD7) scales. The difference in QIDS-SR16 total score, QIDS-SR16 suicidal ideation (SI) item and GAD7 score were analyzed between groups. A total of 209 adults with MDD (n = 177) and BD (n = 26) were included in this analysis. From this sample, 94 patients (mean = 45 ± 13.9 years) met the criteria for anxious-distress. Individuals meeting the criteria for anxious-distress exhibited a significantly greater reduction in QIDS-SR16 total score following four infusions (p = 0.02) when compared with patients not meeting the anxious-distress criteria. Both anxious-distressed and low-anxiety patients exhibited a significant reduction in SI (p < 0.0001) following four infusions.Finally, there was a significantly greater reduction in anxiety symptoms in the anxious-distress group compared with the non-anxious distress group following three (p = 0.02) and four infusions (p < 0.001). Patients with TRD and prominent anxiety receiving IV ketamine exhibited a significant reduction in depressive, SI and anxiety symptoms.

Unanticipated Asystole During Maxillofacial Surgery Due to Activation of the Trigeminocardiac Reflex: What are the Modulating Effects of Intravenous Ketamine and Remifentanil?

Unanticipated Asystole During Maxillofacial Surgery Due to Activation of the Trigeminocardiac Reflex: What are the Modulating Effects of Intravenous Ketamine and Remifentanil?

The Effect of Intravenous Ketamine on Non Suicidal Self Injuries.

The Effect of Intravenous Ketamine on Non Suicidal Self Injuries.

The Effect of Intravenous Ketamine in Suicidal Ideation of Emergency Department Patients.

Suicidal ideation is an emergent problem in the Emergency Department (ED) that often complicates patient disposition and discharge. It has been shown that ketamine possesses fast acting antidepressant and anti-suicidal effects. This study was conducted to examine the effects of a single intravenous bolus of ketamine on patients with suicidal ideations in ED. Forty-nine subjects with suicidal ideations with or without an unsuccessful suicide attempt, received 0.2 mg/kg of ketamine. Scale for suicidal ideation (SSI) and Montgomery-Abserg depression-rating scale (MADRS) were evaluated before and 40, 80 and 120 minutes after drug intervention. The results were compared using the paired t-test and patients were followed up 10 days after ED admission for remnant suicide ideation. SSI (df: 3, 46; F=80.7; p<0.001) and MADRS (df: 3, 46; F=87.2; p<0.001) scores significantly dropped after ketamine injection; the SSI score before and after 20, 40, and 80 minutes of ketamine injection were 23.0±6.7, 16.2±5.2, 14.3±4.3, and 13.6±4.0 respectively. The MADRS scores were 38.2±9.3, 25.6±7.1, 22.7±6.3, and 22.1±5.95 at the same time intervals. 25.5% of patients were hospitalized, 63.3% received medications and 12.2% discharged. 6.2% of patients had suicidal ideations ten days after ED disposition. It seems that Ketamine could not be a good choice for fast reduction of suicidal ideations in ED patients. Further studies are needed to determine the optimal dose of ketamine for different patients.

Intranasal Ketamine for a Neuropsychiatric Condition

Researchers have begun examining the antidepressant effect of intravenous ketamine, an N -methyl-D-aspartate glutamate receptor antagonist and anesthetic (JW Psychiatry Jul 9 2012). Thus, research into potential additional therapeutic uses, especially with an easier-to-administer formulation, is of interest. This controlled, double-blind study …

Ketamine Does Not Increase Intraocular Pressure in Children

To address the common belief that ketamine increases intraocular pressure, researchers prospectively evaluated the effect of intravenous ketamine on

Effect of intravenous ketamine and lidocaine on isoflurane requirement in sheep undergoing orthopedic surgery

Intravenous ketamine and lidocaine infusions may be useful adjuncts to inhalation anesthesia for sheep undergoing orthopedic surgery. In this study, 50 female sheep underwent experimental stifle surgery (29 received a meniscal implant and 21 received sham surgery). To induce anesthesia in the sheep, the authors intravenously injected ketamine and diazepam. They administered isoflurane in oxygen to maintain anesthesia and used mechanical ventilation to maintain normal arterial carbon dioxide pressure. Some sheep received intravenous infusions of ketamine and lidocaine during surgery, whereas others did not. Sheep that received a meniscal implant without ketamine-lidocaine required approximately 23% greater isoflurane concentrations than sheep that were given ketamine-lidocaine. These findings suggest that intravenous infusion of ketamine and lidocaine decreases the requirement for isoflurane during orthopedic surgery on anesthetized sheep.

Suicidal Ideation Abates After Ketamine Infusion

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessSuicidal Ideation Abates After Ketamine InfusionJun YanJun YanSearch for more papers by this authorPublished Online:16 Oct 2009https://doi.org/10.1176/pn.44.20.0021Research conducted in the past few years shows that ketamine leads to a rapid antidepressant effect within hours of administration. A recent study has demonstrated how this mood change translates into a tangible protection against suicidal ideation in treatment-resistant patients with depression (see Original article: Ketamine Leaves BDNF Unchanged for more on ketamine treatment).Ketamine is an anesthetic given intravenously that is often used in surgery and in veterinary medicine. It is known to cause psychosis and has raised abuse concerns. In a paper published in the September 1 Biological Psychiatry, researchers at Mount Sinai School of Medicine, Rutgers University, and Harvard University conducted two clinical studies in which they assessed suicidal ideation in patients with treatment-resistant depression. The study was funded by the National Institutes of Health.Twenty-six patients participated in the first study, in which each received a single infusion of ketamine at a dose of 0.5 mg/kg and was then kept in the hospital for 28 hours. Outcomes were measured 24 hours after the infusion using the single suicide-related item in the Montgomery-Asberg Depression Rating Scale (MADRS-SI). Scores ranged from 0 to 6, with a score of 6 indicating “explicit plans for suicide when there is an opportunity” or “active preparations for suicide.”Subjects' mean score on the MADRS-SI scale decreased from 2.85 before the ketamine infusion to 0.77 at 24 hours after the infusion, which was statistically significant. Before the infusion, 13 patients had a score of 4 or above on the scale. Twenty-four hours after the infusion, eight of the 13 patients had a score of 0 or 1 and three had a score of 2 or 3; two remained at or above a score of 4.Ten of the 26 patients also completed the Implicit Association Test, a behavioral-assessment instrument the researchers used to measure the implicit suicidal intention before and after the infusion. The implicit and explicit suicidal association scores also decreased significantly after the ketamine infusion.Ten of the patients who had been deemed responders in the first study participated in the second study and received repeated ketamine infusions three times a week in a period of 12 days for up to six infusions. Their average MADRS-SI score was 3.0 at baseline. Nine patients scored 0 on the MADRS-SI scale after every repeated infusion. One patient had a score of 2 after the first infusion (baseline score 4). The patient was dropped from further infusion because of lack of response in overall depressive symptoms, defined as at least 50 percent reduction in MADRS total score.The effect of ketamine on suicidal ideation was likely an indirect result of the antidepressant effect of the drug, the authors concluded after they analyzed the correlation between the total score of the nonsuicide-related items in the MADRS and the suicide-related item score. The 26 patients in the single-dose study had an average preinfusion MADRS total score of 37 (scale range 0-60), which decreased to 15 at 24 hours after the infusion. Seventeen of these patients had a 50 percent reduction in MADRS total score.All study participants had moderate to severe depression as indicated by an Inventory of Depression Symptomatology score of 32 or above at baseline and had failed at least two adequate antidepressant trials in the current depressive episode. They had been suffering from major depressive disorder for a mean of 29 years. All had been in the current depressive episode for at least two years and failed an average of six antidepressants in the current episode. Five of the 26 participants had a history of suicide attempts.No patient experienced hallucinations during the studies, Rebecca Price, M.S., a Ph.D. candidate in psychology at Rutgers University and the lead author of the article, told Psychiatric News. The psychotomimetic side effects observed in the studies were “minimal” at this low dose of ketamine, she said, and additional results and analyses are pending publication.The rapid antidepressant effect of ketamine infusion has previously been reported in small clinical trials conducted by researchers at the Mood and Anxiety Disorders Program at the National Institute of Mental Health (NIMH). The NIMH researchers also demonstrated that ketamine's mechanism of action may lie in its antagonism of the NMDA (N-methyl d-aspartate) receptors and subsequent activation of the AMPA (amino-3-hydroxy-5 methylisoxazole-4-propionic acid) receptors; both are biologically activated by the neurotransmitter glutamate (Psychiatric News, September 7, 2007).An abstract of “Effects of Intravenous Ketamine on Explicit and Implicit Measures of Suicidality in Treatment-Resistant Depression” is posted at<www.journals.elsevierhealth.com/periodicals/bps/article/S0006-3223(09)00519-8/abstract>.▪ ISSUES NewArchived

Effects of Intravenous Ketamine on Explicit and Implicit Measures of Suicidality in Treatment-Resistant Depression

Intravenous ketamine has shown rapid antidepressant effects in early trials, making it a potentially attractive candidate for depressed patients at imminent risk of suicide. The Implicit Association Test (IAT), a performance-based measure of association between concepts, may have utility in suicide assessment. Twenty-six patients with treatment-resistant depression were assessed using the suicidality item of the Montgomery-Asberg Depression Rating Scale (MADRS-SI) 2 hours before and 24 hours following a single subanesthetic dose of intravenous ketamine. Ten patients also completed IATs assessing implicit suicidal associations at comparable time points. In a second study, nine patients received thrice-weekly ketamine infusions over a 12-day period. Twenty-four hours after a single infusion, MADRS-SI scores were reduced on average by 2.08 points on a 0 to 6 scale (p < .001; d = 1.37), and 81% of patients received a rating of 0 or 1 postinfusion. Implicit suicidal associations were also reduced following ketamine (p = .003; d = 1.36), with reductions correlated across implicit and explicit measures. MADRS-SI reductions were sustained for 12 days by repeated-dose ketamine (p < .001; d = 2.42). These preliminary findings support the premise that ketamine has rapid beneficial effects on suicidal cognition and warrants further study.

159: The effectiveness of intravenous ketamine and magnesium in patients with postherpetic neuralgia

159: The effectiveness of intravenous ketamine and magnesium in patients with postherpetic neuralgia

The effectiveness of intravenous ketamine and magnesium in patients with postherpetic neuralgia

The effectiveness of intravenous ketamine and magnesium in patients with postherpetic neuralgia