Ketamine Supplementation Research Articles

Against All Odds

Against All Odds

The analgesic efficacy of ketamine for septorhinoplasty: a meta-analysis study.

The analgesic efficacy of ketamine supplementation was not well-established for septorhinoplasty and this meta-analysis aimed to compare ketamine supplementation with placebo for the postoperative pain control of septorhinoplasty. We systematically searched several databases, including PubMed, EMbase, Web of science, EBSCO and Cochrane library databases, and included randomized controlled trials (RCTs) regarding the effect of ketamine supplementation versus placebo for pain control after septorhinoplasty. This meta-analysis was conducted by random effect model. Five RCTs were included in this meta-analysis. In comparison with control group for septorhinoplasty, ketamine supplementation was associated with significantly decreased pain scores at 30min (SMD = -3.84; 95% CI = -6.73 to -0.96; P = 0.009), pain scores at 1h (SMD = -2.70; 95% CI = -3.79 to -1.61; P < 0.00001), pain scores at 2h (SMD = -1.83; 95% CI = -3.01 to -0.64; P = 0.003), rescue analgesics (OR = 0.08; 95% CI = 0.04 to 0.17; P < 0.00001), but unraveled no obvious impact on pain scores at 4h (SMD = -1.13; 95% CI = -3.37 to 1.12; P = 0.32) or the incidence of nausea and vomiting (OR = 0.71; 95% CI = 0.30 to 1.72; P = 0.45). Ketamine supplementation was effective to improve pain relief after septorhinoplasty.

A Randomized Control Trial of Three Intravenous Dexmedetomidine Doses for Procedural Sedation in Patients Undergoing Minor Gynaecological Surgery.

Background: Minor gynaecological procedures are usually done in outpatient settings. Early discharge with minimal haemodynamic compromise is an essential requirement of these procedures. Many sedative drugs are being used for outpatient surgeries. Of the sedative agents available, dexmedetomidine, which has sedative and analgesic sparing effects, has the best safety profile in the cardiorespiratory system. Therefore, we evaluated the optimum dexmedetomidine dose for providing better procedural sedation.Methodology: This randomized, double-blinded study included 120 ASA grade I and II patients aged 18-45 years who were undergoing short gynaecological procedures in a tertiary care hospital. Patients were randomly allocated into three groups of 40 each. After a loading dose of 1 µg/kg over 10 min, group A received dexmedetomidine infusion at a rate of 0.2 µg/kg/hr, group B at a rate of 0.4 µg/kg/hr, and group C at a rate of 0.6 µg/kg/hr. Perioperative hemodynamic changes, intraoperative adjuvant drug requirements, and postoperative recovery were also compared in the three different dexmedetomidine groups.Results: Heart rate, blood pressure, oxygen saturation, and respiratory rate remained within the normal physiological range in all three groups at most perioperative time points. The time to achieve the Modified Aldrete Score and the post-anesthetic discharge scoring system was maximum in group C and minimum in group A. Ketamine had to be supplemented in almost half of the patients in group A and less than a quarter of the patients in group B. In group C, surgery was completed without any drug supplementation. Two patients in group B and four patients in group C had an episode of bradycardia. Oxygen saturation decreased in one patient in group C, necessitating oxygen supplementation.Conclusions: Dexmedetomidine, at a dose of 0.4 µg/kg/hr with ketamine supplementation, provides the most appropriate procedural sedation and analgesia (PSA) without any significant hemodynamic compromise.

Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis

The pain control effect of ketamine versus control in women during cesarean operation is not well determined. The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia. We used meta-analysis to address this concern. Meta-analysis-based study. The databases PubMed, Embase, and the Cochrane Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software. A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD], -1.10; 95% confidence interval [CI], -1.61, -0.59; P < 0.0001). Application of ketamine during cesarean section also resulted in decreased consumption of morphine when compared with the control group (MD, -6.11 mg; 95% CI, -9.93, -2.29; P = 0.002). In addition, the first time required for analgesia was significantly longer in the ketamine group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001). Limited patients were included with moderate strength. Ketamine supplementation during cesarean section reduces pain and morphine consumption and prolongs the postoperative analgesia. Ketamine, cesarean section, randomized controlled trials, meta-analysis.

Ketamine decreases cell viability of bone explants and impairs bone healing in rats

BackgroundKetamine is a widely used anesthetic in experimental medicine. We have also used ketamine for surgical interventions and imaging in rats and found significantly impaired ossification between identically performed experiments, which only differed in the number of anesthetic events. In order to investigate this phenomenon, we estimated the absorbed ionizing radiation and also studied whether ketamine administration has disadvantageous effect on bone cell viability.MethodsSpongious bone chips and parietal bone disks were harvested from rats. Explants were incubated in stem cell media containing 0.02, 0.2 and 2 mM ketamine. After 3 days of incubation, tetrazolium-based spectrophotometric assay was performed to measure cell viability. Size-specific dose estimation was used to calculate ionizing radiation of computed tomography imaging.ResultsWe found that ketamine supplementation with 0.2 mM slightly decreased cell viability, while 2 mM caused significant reduction both in the spongious and cortical explants. The cumulative ionizing radiation was found to be negligible compared to irradiation dosages used to impair ossification.ConclusionsWe conclude that multiple ketamine administration was responsible for the diminished regenerative potential of bone tissue in the present experimental setup. For this reason, we suggest that ketamine anesthesia should be avoided in studies investigating bone regeneration.

The efficacy of ketamine supplementation on pain management for knee arthroscopy: A meta-analysis of randomized controlled trials: Erratum.

The efficacy of ketamine supplementation on pain management for knee arthroscopy: A meta-analysis of randomized controlled trials: Erratum.

The efficacy of ketamine supplementation on pain management for knee arthroscopy: A meta-analysis of randomized controlled trials.

Introduction:The efficacy of ketamine supplementation on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ketamine supplementation for knee arthroscopy.Methods:We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of ketamine supplementation on pain control for knee arthroscopy. This meta-analysis is performed using the random-effect model.Results:Seven RCTs involving 300 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, ketamine supplementation reveals favorable impact on pain scores (mean difference [MD] = –2.95; 95% confidence interval [CI] = –3.36 to –2.54; P < .00001), analgesic consumption (standard mean difference [Std. MD] = –1.03; 95% CI = –1.70 to –0.36; P = .002), time to first analgesic requirement (Std. MD = 1.21; 95% CI = 0.45–1.96; P = .002) and malondialdehyde (Std. MD = –0.63; 95% CI = –1.05 to 3.10; P = –.20), and shows no increase in nausea and vomiting (RR = 1.87; 95% CI = 0.65–3.10; P = .003).Conclusions:Ketamine supplementation benefits to pain management and may reduce ischemia reperfusion injury in patients with knee arthroscopy.

Dose-dependent effect of intrathecal dexmedetomidine on isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy: Effect on block characteristics and hemodynamics.

Background and Aims:Effect of intrathecal dexmedetomidine as an adjuvant to isobaric ropivacaine in spinal anesthesia for abdominal hysterectomy is not much investigated. The objective was to assess the dose dependent effect of dexmedetomidine (3 mcg vs 5 mcg) as an adjunct to isobaric ropivacaine in spinal anesthesia.Materials and Methods:Forty selected female patients were randomized to receive intrathecal 0.5% isobaric ropivacaine (15 mg) with dexmedetomidine 3 mcg (Group D3) or 5 mcg (Group D5) in spinal anesthesia for abdominal hysterectomy. Block characteristics, hemodynamic changes, postoperative analgesia, and adverse effects were compared.Results:Both groups were comparable regarding sensory-motor block characteristics and postoperative analgesia (P > 0.05). Four (10%) patients of Group D5 and 5 (12.5%) of Group D3 could not achieve desired T6 sensory level and Bromage score of 3(complete motor block) hence were converted to general anesthesia at the outset. Nine (22.5%) patients each in both groups required ketamine supplementation (0.5 mg/kg) for intraoperative pain at the time of uterine manipulation. Incidence of hypotension was comparable (55.56% in Group D5 and 37.14% in Group D3, P = 0.11), but this occurred significantly earlier in Group D5, P < 0.001. Sedation was also significantly more in Group D5 as compared with Group D3, P < 0.01.Conclusion:We conclude that spinal anesthesia with isobaric ropivacaine (15 mg) with dexmedetomidine (3 mcg or 5 mcg) did not show much promise for abdominal hysterectomy as one third cases required analgesic supplementation. Both doses of dexmedetomidine produced a similar effect on block characteristic and postoperative analgesia; however, a dose of 5 mcg dose was associated with more hypotension and sedation.

English

Spinal anaesthesia is very popular for cesarean section and currently both hyperbaric and plain solutions of local anaesthesia along with opioids are used. Difference in the baricity can affect the intrathecal distribution of local anaesthetics. AIM: We compared the effects of intrathecal hyperbaric (heavy) 0.5% bupivacaine and isobaric (plain) 0.75%ropivacaine combined with 25micro grams fentanyl regarding the degree of sensory and motor block, quality of intraoperative anaesthesia, side effects and post-operative analgesia in patients undergoing cesarean section by doing a randomized controlled study. MATERIALS AND METHODS: Sixty women undergoing caesarean section were randomized into two groups, Group BF (n=30), group RF (n= 30). Group BF received 10 mg (2 ml) of 0.5% hyperbaric bupivacaine with 25µgs of preservative free fentanyl and Group RF received 15mgs (2ml) 0.75% plain Ropivacaine (isobaric) with 25µgs of fentanyl for spinal anaesthesia. In case of insufficient blocks both the groups were supplemented with analgesic dose of ketamine. RESULTS: No difference was observed in onset time, highest level and recovery of sensory block. Recovery of motor block was slightly prolonged in RF group. The incidence of insufficient block requiring ketamine supplementation and duration of postoperative analgesia was same in both groups. The side effects were also similar in both the groups except for hypotension lower systolic pressure in BF group. The neonatal outcome was unaffected. CONCLUSION: In this study we did not find any difference in the two groups despite difference in density suggesting that the spread of spinal solution is not dependent on density in patients undergoing caesarean section.

Bilateral superficial cervical plexus block with or without low-dose intravenous ketamine analgesia: effective, simple, safe, and cheap alternative to conventional general anesthesia for selected neck surgeries

BackgroundGeneral anesthesia is commonly used for surgery in the neck region. Superficial cervical plexus block is adequate to produce anesthesia in the anterior and anterolateral aspects of the neck. Our aim was to observe the effectiveness of bilateral cervical plexus block for surgery in this region of the neck.MethodsA total of 136 neck surgery cases were enrolled in this prospective uncontrolled study. All patients were administered ropivacaine 0.5% as a bilateral cervical plexus block. The incision line was infiltrated with lignocaine 1% and adrenaline 1:100,000. For thyroglossal cyst and thyroglossal fistula, an additional 1.5 mL of LA solution was deposited over the hyoid bone on both sides of the midline. Any anesthetic inadequacy was corrected using ketamine 25 mg intravenously and repeated if necessary.ResultsOf 37 patients with thyroglossal cyst, the block was sufficient in 36 patients, and one patient required ketamine. Block was adequate in 23 of 24 patients with thyroglossal fistula, and one patient required ketamine. Among the branchial cyst and branchial fistula cases, six of 16 patients required ketamine supplementation. Of three thyroidectomy patients, one required ketamine supplementation, and one was converted to conventional general anesthesia. For lymph node excision and lymph node biopsy patients, LA block was sufficient in all 31 cases. In the last group, one of 25 patients required ketamine supplementation.ConclusionThe overall success of bilateral cervical plexus block as a sole method of anesthesia in these selected neck surgeries was 91.9% and with low-dose ketamine supplementation it approached more than 99%. However, cervical plexus block was not a good method of anesthesia for thyroid surgery in this study. For the remainder of cases, bilateral cervical plexus block alone or in conjunction with ketamine appeared to be a cheap, safe, and effective alternative to conventional general anesthesia.

Comparison of hydroxyethyl starch versus normal saline for epidural volume extension in combined spinal epidural anesthesia for cesarean section

Background: Epidural volume extension (EVE) with saline in the epidural space during a CSE technique can result in cephalad extension of the block and may be accompanied by episodes of hypotension. It also allows CSE to be performed with small initial intrathecal doses of local anesthetic.Objectives: We investigated the difference in block characteristics and hemodynamic profile with CSE-EVE using either saline or colloid in the epidural space.Materials and Methods: This prospective, randomized, controlled study was conducted in 99 parturients, ASA grade I or II, with gestational age 37 weeks or more, undergoing elective cesarean section under CSEA. Women were randomly distributed into three groups: Group NEVE (CSE with no EVE), Group EVE-S (CSE followed by EVE using 5 ml of 0.9% saline), and Group EVE-H (CSE followed by EVE using 5 ml of 6% hydroxyethyl starch (HES) 200/0.5). All the groups received 6 mg of 0.5% hyperbaric bupivacaine with 25 mcg fentanyl intrathecally, while Groups EVE-S and EVE-H also received 5 ml of saline or HES in the epidural space. All blocks were performed using needle through needle CSE technique via midline approach at the L 4-5 interspace with the women in the left lateral position. Block characteristics and hemodynamic parameters were recorded by an independent anesthesiologist. Data were compared with Chi-square, t test, and ANOVA using Epi info 6 with P < 0.05 as significant.Results: The peak sensory level and the time taken to achieve it was significant in Group EVE-S (P = 0.003 temperature, P = 0.007 pinprick, P = 0.000 time) as compared to Group NEVE while Group EVE-H was intermediate as compared to the other two groups. In Group EVE-S, there was a difference in the mean peak sensory levels as assessed by temperature (thoracic T 4.88±1.01 ) and pinprick (T 5.04±1.02 ), whereas it was the same in the other two groups (T 6.10±1.41 in Group NEVE and T 5.44±1.35 in Group EVE-H). The requirement for ketamine supplementation was significantly more in Group NEVE (54.5%) as compared to Group EVE-S (24.2%) and Group EVE-H (27.3%), P = 0.018. The motor block characteristics were comparable in all the three groups (P > 0.05).The lowest attained values of heart rate, systolic, and diastolic blood pressure were significantly less in Group EVE-S versus Group NEVE (P = 0.019, 0.008, and 0.001, respectively), while hemodynamic parameters in Group EVE-H were intermediate. Incidence of hypotension was significantly more in Group EVE-S (n = 20, 60.6%), as compared to Group NEVE (n = 9, 27.3%, P = 0.02) and Group EVE-H (n = 13, 39.4%).Conclusion: We conclude that an intrathecal dose of 6 mg hyperbaric bupivacaine with 25 mcg fentanyl is adequate for cesarean section when used in CSE with the EVE technique, using 0.9% saline or 6% HES. However, EVE with HES provides optimal hemodynamic profile as compared to EVE with saline.

Small dose clonidine plus ketamine supplementation of remifentanil-based anesthesia: effect on perioperative opioid analgesic requirements

Gorgias, N.; Zaralidou, A.; Karakoulas, K.; Amaniti, E.; Petkopoulou, M.; Tzanakopoulou, V.; Maidatsi, P. Author Information

Ketamine supplementation of bupivacaine and fentanyl extradural anaesthesia for the control of pain following total hip arthroplasty

s and Programme: European Society of Anaesthesiologists; 9th Annual Meeting with the Swedish Society of Anaesthesiology; Gothenburg, Sweden, 7-10 April 2001: Acute and Chronic Pain Management

Anesthesia in female white-tailed deer using Telazol and xylazine.

Thirty two free-ranging female white-tailed deer (Odocoileus virginianus) were anesthesized with varying Telazol and xylazine HCl combinations in Front Royal (Virginia, USA) between August 1992 and September 1992. All animals were caught in baited box traps, manually restrained, and hand injected with a combination of Telazol and xylazine administered intramuscularly. Deer received mean +/- SE dosages of 2.53+/-0.16 mg/kg Telazol and 0.69+/-0.05 mg/kg of xylazine. These dosages achieved a rapid and effective anesthetic plane for short-term procedures such as weighing, blood collection, and translocation. Eight of 32 deer (25%) required an intravenous (i.v.) supplement of ketamine HCl (100 mg) to maintain a safe plane of anesthesia. Ketamine supplementation provided an average of 11.8+/-2.0 min additional safe handling. Satisfactory reversals were achieved in all deer by administering yohimbine HCl 16 mg i.v. (dose range, 0.22 to 0.48 mg/kg) to all animals.