Total Ketamine Dose Research Articles

Opioids Safety in Pediatric Procedural Sedation with Ketamine

To evaluate the effects of pre- and intraprocedural opioids on adverse events in children undergoing procedural sedation with ketamine in the emergency department (ED). We conducted a retrospective cohort study of all children aged 0-18years who underwent procedural sedation with intravenous ketamine alone, or in combination with an opioid, at a tertiary-care pediatric ED between June 1, 2018, and August 31, 2020. We explored predictors of serious adverse events (SAEs), desaturation or respiratory intervention, and vomiting. Of 1164 included children (694 male, 59.6%; median age 5.0years [IQR 2.0-8.0]), 80 (6.8%) vomited, 63 (5.4%) had a desaturation or required respiratory interventions, and 6 (0.5%) had SAEs. Pre- and intraprocedural opioids were not independent predictors of sedation-related adverse events. A concurrent respiratory illness (aOR 3.73; 95% CI 1.31-10.60, P=.01), dental procedure (aOR 3.05; 95% CI 1.25-7.21, P=.01), and a greater total ketamine dose (aOR 1.75; 95% CI 1.21-2.54, P=.003) were independent predictors of desaturation or respiratory interventions. A greater total ketamine dose (aOR 1.86; 95% CI 1.16-2.98, P=.01) and older age (aOR 1.15; 95% CI 1.07-1.24, P<.001), were independent predictors of vomiting. Pre- and intraprocedural opioids do not increase the likelihood of sedation-related adverse events. SAEs are rare during pediatric procedural sedation with ketamine in the ED.

Comparison of two doses of ketamine for induction of anaesthesia in ponies undergoing field castration.

Background:Ketamine-based total intravenous anaesthesia techniques are commonly used in equine practice for ponies requiring short procedures such as castration in field conditions. When a longer duration of recumbency than provided by the initial dose of anaesthetic agents is required, administration of supplementary ‘top-up’ doses of anaesthetic agents is required. Ideally, a single dose of anaesthetic agents would reliably achieve a longer duration of action whilst maintaining adequate anaesthetic, surgical and recovery qualities.Aim:This prospective, randomised and blinded study aimed to compare the UK-licensed induction dose of ketamine with an increased dose in ponies undergoing castration in field conditions. The hypothesis was that an increased dose would produce a longer duration of action without negatively affecting qualities of anaesthesia, surgical conditions and recovery.Methods:Ponies were randomly allocated to receive ketamine at either 2.2 mg kg-1 (K2.2) or 3 mg kg-1 (K3) combined with diazepam 20 μg kg-1 following pre-anaesthetic medication with romifidine and butorphanol. Quality of anaesthesia, surgery and recovery were scored using simple descriptive scales (SDS) and timings of key events recorded. Top-up doses of ketamine 0.5 mg kg-1 were administered if anaesthesia was inadequate during surgery. Time of top-up doses and total ketamine doses were recorded. Data were analysed using Student t-tests or the Mann-Whitney U test (p < 0.05).Results:Thirty-six ponies completed the study. Six ponies enrolled were excluded due to cryptorchidism or surgical complications that required deviation from the anaesthetic protocol. There were no differences in timing of events recorded, number of ponies requiring top-up ketamine, timing and frequency of top-ups or total ketamine dose. Scores for anaesthetic and recovery qualities, and surgical conditions were similar between groups.Conclusion:Both induction doses of ketamine provided a similar duration of action and provided conditions suitable to anaesthetise ponies undergoing castration.

Systematic Review of the Use of Intravenous Ketamine for Fibromyalgia.

Background: Fibromyalgia, a complex disorder that affects 1% to 5% of the population, presents as widespread chronic musculoskeletal pain without physical or laboratory signs of any specific pathologic process. The mechanism, while still being explored, suggests central sensitization and disordered pain regulation at the spinal cord and supraspinal levels, with a resulting imbalance between excitation and inhibition that may alter central nervous system nociceptive processing. Nociceptive hypersensitivity results from activity of the N-methyl-D-aspartate receptor (NMDAR)–mediated glutamatergic synaptic transmission in the spinal cord and brain. Because ketamine, an NMDAR antagonist, may reduce induction of synaptic plasticity and maintenance of chronic pain states, the study of its use in intravenous form to treat fibromyalgia has increased.Methods: We conducted a literature search with the objectives of examining the effect of intravenous ketamine administration on pain relief, identifying side effects, and highlighting the need for clinical studies to evaluate ketamine infusion treatment protocols for patients with fibromyalgia. We used the keywords “fibromyalgia,” “chronic pain,” “ketamine,” “intravenous,” and “infusion” and found 7 publications that included 118 patients with fibromyalgia who met inclusion criteria.Results: Clinical studies revealed a short-term reduction—only for a few hours after the infusions—in self-reported pain intensity with single, low-dose, intravenous ketamine infusions, likely attributable to nociception-dependent central sensitization in fibromyalgia via NMDAR blockade. Case studies suggest that increases in the total dose of ketamine and longer, more frequent infusions may be associated with more effective pain relief and longer-lasting analgesia. Another neurotransmitter release may be contributing to this outcome.Conclusion: This systematic review suggests a dose response, indicating potential efficacy of intravenous ketamine in the treatment of fibromyalgia.

A comparison of analgesia requirements in children with burns: Do delayed referrals require higher procedural analgesia doses?

BackgroundOur clinical impression is that delayed referrals require more analgesia than children referred to our service acutely. Previous work demonstrated poor uptake of analgesia protocols at district hospitals with probable inadequate background and procedural analgesia, which may account for this. The purpose of this study was to compare analgesia requirements for dressing changes of paediatric patients referred to us acutely versus those children with delayed referral (i.e. more than 21 days post injury). Our hypothesis is that paediatric patients with delayed referral require higher doses of ketamine when taking length of stay and total body surface area (TBSA) of the burn into account. MethodsData for children under 12 years, admitted to the Pietermaritzburg Burn Service (PBS) from the 1 July 2017 until 30 June 2018 was reviewed. Total ketamine dose during admission, weight, days admitted and TBSA were analysed. The total ketamine use in milligram per kilogram per days admitted per TBSA (mg/kg/days admitted/TBSA) was calculated. Statistical analysis was performed to compare the total ketamine dose between the acute and delayed referral groups. ResultsOne-hundred-and-ninety-seven patients were included. Patients were divided into two groups, the acute group including those referred to the PBS early (prior to 21 days post-burn) and the delayed referral group (those referred 21 days or more post burn). The acute group consisted of 167 patients and the chronic group 30 patients. There is a statistically significant difference between the total ketamine dose (mg/kg/days admitted/TBSA) for the acute referral and delayed referral groups (p = 0.01). The median total ketamine dose (mg/kg/days admitted/TBSA) of the acute referral group was 0.27 (Range: 0–7.05) and the median total Ketamine dose (mg/kg/days admitted/TBSA) for the delayed referral group was 0.41 (range: 0.1–3.89). ConclusionPatients with delayed referrals require more ketamine to achieve adequate procedural analgesia than patients referred acutely. Inadequate analgesia in the acute phase of the burn may influence this, underpinning the importance of adequate analgesia right from the time of the injury.

The utility of intravenous ketamine for the management of intraoperative penile erection: a retrospective single-center analysis of endourological surgeries over a 4-year

BackgroundTo assess the prevalence of intraoperative penile erection in our endourology practice and the utility of intravenous ketamine in the management of the condition.MethodsOf 402 endoscopic urological procedures performed in our clinic over a 4-year (2015–2019) period, a total of 9 cases with intraoperative penile erection impeding instrumentation during endourological surgery were included. Data on patient age, weight, height, American Society of Anesthesiologists (ASA) physical status classification system scores, type and duration of surgery, type and level of anesthesia, onset of erection, treatment characteristics and treatment outcome were recorded for each patient.ResultsThe mean (SD) age was 68.3 years (range, 66.0–77.0 years). ASA physical status category I and II were noted in 55.6 and 44.4% of patients, respectively. All cases received spinal anesthesia (n = 9) at T8–10 dermatome levels, for TURP in 7 (77.8%) cases and for TURBT in 2 (22.2%) cases. The onset of penile erection was post-urethroscope in 7 (77.8%) cases. The average total ketamine dose was 34.3 mg (range, 18.0–75.0 mg). The average duration of the operation was 91.7 min (range, 40.0–140.0 min). Ketamine treatment resulted in resolved erection with delayed procedure in 7 (77.8%) cases, while conversion to general anesthesia was required in 2 (22.5%) cases.ConclusionsIn conclusion, the prevalence of intraoperative penile erection during spinal anesthesia for endourological surgery was 2.2% in our experience. These findings demonstrated that intravenous injection of ketamine is an effective and safe method for immediate resolution of intraoperative penile erection with a high success rate.

A Comparison of Ketamine-Dexmedetomidine versus Ketamine-Propofolfor Sedation in Children during Upper Gastrointestinal Endoscopy

Background: Upper gastrointestinal endoscopy in pediatric patients have increased and become more frequent. Selection of a sedative with hemodynamic stability, rapid onset, short action and few side effects is essential. Material and methods: 60 ASAI/II patients between the age of 2-12 yrs of both sexes undergoing upper gastrointestinal endoscopy randomly allocated into two groups, 30 patients each, all patients received ketamine 1 mg/kg intravenous, then group KD received dexmedetomidine 1 μg/kg bolus dose slowly IV and patients in Group KP received propofol 1 mg/kg as initial doses then top-up doses of 2-4 ml of the prepared solutions were given till RSS of ≥ 5. Hemodynamic parameters, total ketamine dose, time to RSS ≥ 5 and PADSS of 9-10, side effects and Parents’ and Endoscopists’ satisfaction were recorded. Results: HR was significantly lower in group KD at T1, T2 and T3, no significant difference as regard MAP, RR, SpO2 and time to achieve RSS and PADSS (p>0.05), significantly higher total ketamine dose in group KD than group KP (P=0.001), Parents’ and Endoscopists’ satisfaction was significantly higher in group KD than KP (p<0.05). Conclusion: Ketamine-dexmedetomidine for sedation in children during upper gastrointestinal endoscopy is an effective, reliable and safe alternative to ketamine-propofol without hemodynamic or respiratory drawbacks with comparable onset and recovery time.

小児心臓手術後におけるデクスメデトミジンと抑肝散併用療法の鎮静効果

Objectives: The study was conducted to compare the combined effect of dexmedetomidine (DEX) and oral or suppository Yokukansan (YKS) on sedation after cardiac surgery in pediatric patients. Methods: Eighteen postoperative patients were divided into three groups according to YKS combined with continued administration of DEX: non-YKS (NY) group, gastric tube (oral) YKS (GY) group, and intrarectal suppository YKS (RY) group. YKS was administered at a dose of 0.1 g/kg every four hours. The sedation level was evaluated using Richmond Agitation-Sedation Scale and Behavioural Observational Pain Scale, and ketamine was administered for patients with scores ≥2 in either scales. The total dose of ketamine administered per body weight was used to define the sedative effect. Results: The ketamine dose (median) was 1.5, 1.0, and 0 mg/kg/day in NY, GY, and RY groups, respectively. Compared with the NY group, the GY group used less ketamine but the difference was not significant (P=0.49) and the RY group used a significantly lower dose (P=0.03). Conclusions: The combination of DEX and suppository YKS was effective for sedation in children after cardiac surgery, while DEX combined with gastric tube (oral) YKS was not sufficient in efficacy.

Deep sedation in GreenLight laser prostatectomy

Introduction:Evaluation of ketamine and propofol combination for the performance of photoselective vaporization of prostate (PVP).Patients and Methods:Twenty-six patients undergoing PVP for benign prostatic hyperplasia were included in the study. Co-morbidities were present in 24 patients. Midazolam 2 mg intravenous was administered for the induction to anesthesia. Propofol (10 mg/ml) and ketamine (1 mg/ml) were administered with the use of two pumps. An initial bolus dose of 0.03 ml/kg of propofol and 5 mg of ketamine was administered intravenously. The anesthesia was maintained by continuous infusion of 0.01 ml/kg/min of propofol and 2 ml/min of ketamine. Fentanyl was administered when deemed necessary. The level of sedation, peri-operative parameters and side-effects were recorded.Results:The average periods from the induction of anesthesia and intraoperative infusion were 12.38 ± 5.84 min and 59.5 ± 22.15 min, respectively. Average propofol and total ketamine dose were 85.5 ± 10.62 μg/kg/min and 144.9 ± 45.62 mg, respectively. The average dose of fentanyl administered was 29.81 ± 27.40 μcg. An average period between the end of the infusion and the discharge to the urology clinic was 34.62 ± 22.89 min. Ten patients experienced nausea and five eventually vomited. Hallucinations were observed in five cases while visual disturbances in two patients.Conclusion:The combined use of ketamine and propofol for the performance of PVP proved to be an efficient method for anesthesia. The “deep sedation” provided by these drugs was not associated with significant side-effects. Moreover, the use of the above method is indicated in patients with significant co-morbidities that should undergo PVP.

Clinical Efficacy of Combination of Propofol and Ketamine(Ketofol) for Deep Sedation in Colonoscopic Procedure

AIM: To compare and evaluate the clinical efficacy of the combination of propofol and ketamine (ketofol) versus propofol alone when each regimen is used as sedative agents for colonoscopy. METHODS: 100 patients who underwent colonoscopy in two years, were randomly assigned to PN and PK groups. 50 patients in group PN received propofol and normal saline and 50 patients in group PK received propofol and ketamine for deep sedation. All patients were premedicated with 0.02-0.03 mg/kg of midazolam. Immediately after the procedure, the endoscopist was asked to rate tolerability for the patient, discomfort during insertion and satisfaction. As well, a blinded member of the research team evaluated the patient satisfaction, procedural pain, recovery time and recovery score. The primary outcome was the successfully completed colonoscopic procedure. The secondary outcome variables were patient tolerance, discomfort during insertion, patient and endoscopist satisfaction, recovery time and recovery score, hemodynamic parameters, as well as adverse events during and immediately after procedure. RESULTS: All endoscopies were completely successfully. Mean total dose of midazolam in group PK and PN was 0.027±0.005 mg/kg and 0.026±0.005 mg/kg, respectively (p=0.469). Mean total dose of propofol in group PK and PN was 7.28±3.03 mg/kg/h and 8.02±2.99 mg/kg/h, respectively (p=0.451). Mean total dose of ketamine in group PK was 1.49±0.61 mg/kg/h. There were no significant differences in the patient and endoscopist satisfaction, procedural pain and recovery time, but the recovery score at 30 min post-procedure in group PK was significantly lower than group PN (p=0.025). Tolerability of the patient and comfort during insertion in group PN were statistically significantly lower than the patients in group PK. Overall and sedation-related adverse event rate in group PN were also significantly higher than in group PK. However, these adverse events were transient and easily treated with no sequelae. CONCLUSION: Deep sedation in both regimens provided effective and safe for colonoscopy. No serious adverse events were observed. However, the combination of propofol and ketamine (ketofol) used as sedative agents for deep sedation had significantly higher efficacy than the propofol alone.

Buprenorphine provides better anaesthetic conditions than butorphanol for field castration in ponies: results of a randomised clinical trial

A prospective, randomised, blinded, clinical trial in 47 ponies compared butorphanol and buprenorphine administered intravenously with detomidine prior to castration under anaesthesia. Detomidine 12 μg/kg intravenously was followed by butorphanol...

Evaluating the hematoma block as an adjunct to procedural sedation for closed reduction of distal forearm fractures.

Although procedural sedation using intravenous agents is highly effective for forearm fracture reduction, the process is both resource and time intensive. Our objective was to determine whether the use of a hematoma block as an adjunct to procedural sedation with ketamine and midazolam reduces (1) pain during the procedure (scored using the Observational Score for Behavioral Distress-Revised score) or (2) the excess sedation time, defined by the time between procedure completion and discharge from sedation. Our secondary outcome measure was total ketamine dose administered during the procedure. A randomized, double-blind, placebo-controlled clinical trial was conducted. Before fracture reduction, children 3 to 17 years of age randomly received 2% lidocaine (L) or normal saline (NS) into the hematoma of their fracture site during sedation with intravenous ketamine and midazolam. Ninety patients were randomized: 50 to L and 40 to NS. The groups were similar with regard to age, sex, type of fracture, and prior administration of pain medication. Median Observational Score for Behavioral Distress-Revised scores were 1.11 and 1.69 for the L and NS groups, respectively (P = 0.23). Excess sedation time was not significantly different between the groups (P = 0.36), with a median excess sedation time of 33.0 and 36.0 minutes for the L and NS groups, respectively. Mean ketamine dose administered was not different between the groups (P = 0.42). The mean total dose administered was 1.00 mg/kg and 1.07 mg/kg in the L and NS groups, respectively. Mean midazolam dose was 0.05 mg/kg for both groups. The use of a hematoma block as an adjunct to procedural sedation with ketamine and midazolam for forearm fracture reduction conferred no additional benefit and did not decrease observed pain scores, excess sedation time, or total ketamine dose administered.

Dexmedetomidine and ketamine sedation for muscle biopsies in patients with Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) possesses many potential challenges for anesthetic care. Invasive and noninvasive procedures with corresponding sedation or general anesthesia are frequent and necessary for affected patients. There remains a need for a better agent or agents for procedural sedation in patients with comorbid diseases. This study prospectively evaluated a combination of ketamine with two different doses of dexmedetomidine for sedation during muscle biopsy in patients with DMD. Dexmedetomidine 1.0 or 0.5 μg·kg(-1) was administered as a loading dose over 3 min followed by a continuous infusion of 1.0 or 0.5 μg·kg·h(-1). Ketamine (1 mg·kg(-1)) was administered along with the dexmedetomidine loading dose. As the procedure commenced, additional doses of ketamine (0.5 mg·kg(-1)) were administered as needed. Sedation scores, hemodynamic data, operative times, and recovery times were recorded. The study cohort included a total of 53 bicep, deltoid, or anterior tibialis muscle biopsies in 19 boys including 24 in the dexmedetomidine 1.0 μg·kg(-1) group and 29 in the dexmedetomidine 0.5 μg·kg(-1) group. Mean age and weight were 9.7 ± 1.4 years and 33.3 ± 7.7 kg in the dexmedetomidine 1.0 μg·kg(-1) group and 8.8 ± 1.8 years and 30.2 ± 10.8 kg in the dexmedetomidine 0.5 μg·kg(-1) group. No significant changes in blood pressure were noted. A decrease in heart rate (HR) occurred after the loading dose of dexmedetomidine in both groups. The HR was significantly lower in the dexmedetomidine 1.0 μg·kg(-1) group compared with the dexmedetomidine 0.5 μg·kg(-1) group. Total recovery time to discharge was significantly shorter in the dexmedetomidine 0.5 μg·kg(-1) group than the dexmedetomidine 1.0 μg·kg(-1) group (146 ± 65 vs 174 ± 58 min; P = 0.03), although the total ketamine dose was significantly greater in the dexmedetomidine 0.5 μg·kg(-1) group (3.7 ± 1.0 vs 2.0 ± 0.5 mg·kg(-1); P < 0.01). There were no episodes of apnea or hypoventilation; however, a jaw thrust was needed in one patient in the dexmedetomidine 1.0 μg·kg(-1) group. The combination of dexmedetomidine and ketamine is safe and effective for moderately painful procedures with limited respiratory and cardiovascular effects in a high-risk patient population. Dexmedetomidine 0.5 μg·kg(-1) as a loading dose with ketamine followed by a continuous infusion of dexmedetomidine at 0.5 μg·kg(-1) ·h(-1) achieved an adequate sedation level with shorter total recovery times in the perioperative unit compared with a higher dose regimen of dexmedetomidine (1.0 μg·kg(-1) loading dose followed by an infusion at 1.0 μg·kg(-1) ·h(-1)).

PWE-105 Clinical efficacy of the combination of propofol and ketamine (ketofol) for deep sedation for colonoscopy

IntroductionA combination of propofol and ketamine is usually used to achieve sedation and analgesia during colonoscopy. Few studies have compared their efficacy. The aim of this study was to compare...

The Effect of Ketamine with Remifentanil for Improving the Quality of Anaesthesia and Recovery in Paediatric Patients Undergoing Middle-Ear Ventilation Tube Insertion

This prospective randomized study evaluated the effects of ketamine with remifentanil to improve the quality of anaesthesia and postoperative recovery, following brief procedures, in 60 paediatric patients undergoing middle-ear ventilation tube insertion (MEVTI). Patients were randomly assigned to either ketamine 2 mg/kg intravenous [i.v.] bolus plus normal saline by i.v. infusion (K group, n = 30) or ketamine 2 mg/kg i.v. bolus, plus remifentanil 0.15 μg/kg per min i.v. infusion (KR group, n = 30). Parameters that were assessed included intraoperative patient movement, surgeon satisfaction, anaesthesia time, total ketamine dose, postoperative recovery time, agitation and side-effects. Intraoperative patient movement scores were significantly lower, and surgeon satisfaction scores were significantly higher, in the KR group than in the K group. Time to recovery was significantly shorter in the KR group than in the K group. In conclusion, remifentanil was a good adjuvant to ketamine, improving the quality of anaesthesia and postoperative recovery in children undergoing MEVTI.

Ketamine-Associated Vomiting

Vomiting is a common adverse event after emergency department ketamine sedation in children. We sought to determine if the rate of vomiting is dose related to intravenous ketamine. Treating physicians administered intravenous ketamine to children requiring sedation for a procedure in a pediatric emergency department using doses of their discretion in this prospective observational study. We compared initial and total ketamine doses between children with and without vomiting directly and after controlling for age and coadministered drugs using multiple logistic regression analysis. A wide range of initial (0.2 to 2.4 mg/kg) and total (0.3 to 23.8 mg/kg) ketamine doses were administered in the 1039 sedations studied. Vomiting occurred in 74 (7%) overall. Initial and total ketamine dose distributions were similar in children with and without vomiting (medians 1.6 vs 1.6 mg/kg and 2.2 vs 2.1 mg/kg, respectively). Our multivariate analysis found no significant association between emesis and initial dose; however, it did reveal an association with total dose that was explained by a minority (3.5%) of children who received high cumulative doses (>7 mg/kg). The rate of emesis was 7.0% when the total ketamine dose was 7 mg/kg or less and 11.1% when greater than 7 mg/kg. Within a wide range of intravenous doses, ketamine-associated vomiting is not related to either the initial loading dose or the total dose--except for a modest increase for those receiving high cumulative doses (>7 mg/kg).

Evaluation of Propofol‐Ketamine Anesthesia for Children Undergoing Cardiac Catheterization Procedures

The aim of this study was to assess the safety and efficacy of the continuous intravenous administration of a combination of propofol and ketamine for children undergoing cardiac catheterization procedures (CCP). Thirty-two children scheduled for CCP in a university teaching hospital were included in this prospective randomized study. Patients in group 1 (n = 15) were given a combination of propofol (25 microg/kg per minute) and ketamine (25 microg/kg per minute), whereas patients in group 2 (n = 17) received a combination of propofol (25 microg/kg per minute) and ketamine (12.5 microg/kg per minute) for the maintenance of anesthesia. There were no statistically significant differences with age, weight, duration of the procedure, and the number of diagnostic and interventional procedures between the two groups. There was no hemodynamic instability, airway compromise, excessive salivation, or arterial desaturation in either of the two groups. There was more incidence of movements in patients who received less dose of ketamine; however, it did not reach to statistically significant level. The total dose of ketamine used in group 1 was 309.25 +/- 90.97 microg/min, whereas in group 2, it was 148.06 +/- 34.05 microg/min. The time to awakening was significantly less in group 2 (P < 0.05). We conclude that a combination of propofol (25 microg/kg per minute) and two different doses of ketamine (25 and 12.5 microg/kg per minute, respectively) are safe and efficacious for CCP in children. Although the time to awaken was more in patients receiving 25 microg/kg per minute of ketamine compared to those receiving 12.5 microg/kg per minute of ketamine, it was well within acceptable limits.

Low-Dose Ketamine

Intravenous (IV) ketamine has gained widespread use in the emergency department (ED) for procedural sedation. The most commonly recommended starting dose is 1.5 mg/kg. We examined whether lower doses of ketamine in the range of 0.5 to 1.0 mg/kg could successfully sedate pediatric patients. We retrospectively reviewed quality assurance data of patients sedated with IV ketamine in a pediatric ED. Patients were administered 0.02 mg/kg of IV atropine, 0.05 mg/kg of IV midazolam, and then 0.5 mg/kg of IV ketamine. Additional aliquots of 0.25 to 0.5 mg/kg of ketamine were given as necessary, to a maximum of 2.0 mg/kg. Efficacy of sedation was assessed after every dose by pediatric emergency medicine attendings or fellows. Seventy-two patients had quality assurance forms completed. The total ketamine dose administered ranged from 0.5 to 2 mg/kg. Adequate procedural sedation was obtained for 70 (97%) of 72 patients. Forty-four percent of patients required 0.75 mg/kg or less of ketamine to obtain adequate initial sedation; 25% of subjects required only 0.5 mg/kg; 43% of patients required 1.0 mg/kg of IV ketamine. We found that 88% of our patients could be successfully sedated at initial doses of 1 mg/kg or less. Our study suggests a potential role for low-dose IV ketamine in the range of 0.5 to 1.0 mg/kg for pediatric procedural sedation. Most pediatric ED patients can be successfully sedated with 1 mg/kg of ketamine.

Low-dose ketamine with clonidine and midazolam for adult day care surgery

Low-dose ketamine with clonidine and midazolam for adult day care surgery

Propofol-ketamine versus propofol-fentanyl for outpatient laparoscopy : Comparison of postoperative nausea, emesis, analgesia, and recovery

Study objective To compare postoperative nausea, emesis, analgesia, and recovery between propofol-ketamine and propofol-fentanyl in outpatient laparoscopic tubal ligations with general anesthesia. Study design Prospective, randomized, blinded study. Setting Tertiary-care women’s hospital. Patients 120 ASA physical status I and II ambulatory patients scheduled for elective laparoscopic tubal ligation. Interventions Patients were randomized to two groups to receive either ketamine (1-1.5 mg/kg) or fentanyl (3-5 μg/kg). Measurements Measured variables included total dose of ketamine, fentanyl, propofol, and operating time. Vital signs, pain visual analog scale scores (VAS), nausea VAS, presence of emesis, treatment for nausea and vomiting, pruritus, sedation, and presence of dreaming were recorded on postanesthesia care unit (PACU) admission, PACU discharge, stepdown unit admission, and hospital discharge. Results are expressed as means ± SD or medians and analyzed using t -test, Chi-square, or Mann-Whitney (p < 0.05). Main results No differences were noted with respect to propofol dose, operating times, pain or nausea VAS scores, emesis, treatment for nausea and vomiting, pruritus, and sedation on PACU admission, PACU discharge, stepdown unit admission, and hospital discharge. The ketamine group had a higher heart rate, required more pain medication, and had a higher frequency of dreaming on PACU admission than the fentanyl group. These differences became insignificant on PACU discharge. Conclusions For outpatient laparoscopic tubal ligations with general anesthesia, propofol-ketamine does not improve postoperative nausea, emesis, analgesia or recovery compared with the propofol-fentanyl combination.

０．１％ケタミン微量持続点滴麻酔法 基礎的研究とその臨床応用

This study evaluated a new method to use 0.1% Ketamine Hydrochloride solution as an ideal approach to anesthesia for small animals. The Ketamine HCL was used primarily as an analgesic rather than as an anesthetic agent. In this report we present the data from both our experimental study of 22 cases and clinical study of 1455 patients anesthetized with 0.1% Ketamine HCL by intravenous“Micro-Mini”drip administration technique. For the experimental study, 20 dogs and 2 cats were used. They were examined the general clinical symptoms and hemo-dynamics during the anesthesia.Among the 1455 patients of clinical study, the 1051 were dogs and the 404 were cats. Of the dogs, 491 were males and 560 were females. The average body weight was 9.59 kg. AS for the cats, the 144 were males and 260 were females. The average body weight was 3.28 kg. All of them were also anesthetized with the same method as the experimental study. The general symptoms, duration of anesthetic time and the dose of Ketamine HCL were carefully observed. This anesthetic method was applied to various surgical procedures. Both the experimental and the clinical studies showed an eminently desirable results. In case of the clinical application of 1051 dogs, the anesthetic average time was 64 minutes. The average does of ketamine HCL was 6.01 mg per kg (SD±4.638), 6.07 mg per kg per hour (SD±4.76) .In clinical case of 404 cats, the anesthetic average time was 55 minutes. The average dose of Katamine HCL was 9.21 mg per kg (SD±5.05), 11.16 mg per kg per hour (SD±6.19) . The total dose of Ketamine HCL was extremely less compared with the former Ketamine intramuscular administration method, especially for the high risked patients. In case of the patients applied with the combination use of Ketamine HCL and relaxant, the total dose of Ketamine could be reduced remarkably.