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Ketamine

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6001. [Effect of low-dose intravenous ketamine in postoperative analgesia for hysterectomy and adnexectomy]. (Abstract)

[Effect of low-dose intravenous ketamine in postoperative analgesia for hysterectomy and adnexectomy]. To evaluate the efficacy of low dose ketamine (0.15 mg/Kg i.v.) as a pre-emptive pain relief after general anesthesia.Sixty-nine gynecological surgery patients were enrolled in this prospective, double-blind study. All received total intravenous anesthesia and were randomized to group A (n = 23) to receive preoperative ketamine, to group B (n = 23) to receive postoperative ketamine or to group (...) min) than in group A (6.68 +/- 3.64 min; p < 0.05) or in group C (8 +/- 4 min). The first analgesic dose was infused later in group B (45.24 +/- 16.16 min; p < 0.001) than in group A (26.45 +/- 11.65 min) or in group C (25.47 +/- 9.19 min). The pain scores at rest were similar. On the fifth day, pain upon movement was less intense for patients treated with ketamine (group A 12 [10-21] and group B 13.5 [2-22]) than in patients treated with placebo (group C 23 [15.5-36.75]) (p < 0.05 group C vs

2002 Revista española de anestesiología y reanimación Controlled trial quality: predicted high

6002. A comparison of thiopental, propofol, and diazepam-ketamine anesthesia for evaluation of laryngeal function in dogs premedicated with butorphanol-glycopyrrolate. (Abstract)

A comparison of thiopental, propofol, and diazepam-ketamine anesthesia for evaluation of laryngeal function in dogs premedicated with butorphanol-glycopyrrolate. Thiopental, propofol, and diazepam-ketamine were compared for evaluation of laryngeal function in dogs. There was no significant difference among the three protocols in time to observation of normal function after drug administration or in the occurrence of swallowing, laryngospasm, or breathing. Jaw tone was significantly greater (...) with diazepam-ketamine. Exposure of the larynx was excellent in five dogs and moderate in three dogs, each receiving thiopental or propofol. Exposure was excellent in one dog, moderate in six dogs, and poor in one dog receiving diazepam-ketamine. Exposure of the larynx for laryngeal function evaluation is more readily accomplished with thiopental or propofol than with diazepam-ketamine.

2002 Journal of the American Animal Hospital Association

6003. Postoperative pain relief after hepatic resection in cirrhotic patients: the efficacy of a single small dose of ketamine plus morphine epidurally. (Abstract)

Postoperative pain relief after hepatic resection in cirrhotic patients: the efficacy of a single small dose of ketamine plus morphine epidurally. In cirrhotic patients undergoing hepatic surgery, postoperative analgesia remains a challenge. In this study, we evaluated the efficacy of a single dose of morphine combined with small-dose ketamine given epidurally for postoperative pain relief. One-hundred-four classification "Child A" cirrhotic patients were randomly assigned to two groups: 1 (...) ) (MKG, n = 54): epidural morphine (3.5-5 mg) plus ketamine (20/30 mg); and 2) epidural morphine (3.5/5 mg) (MG, n = 50). The level of analgesia, side effects, psychomimetic and neurological disorders, additional analgesic needs, and overall quality of the analgesia were recorded. The mean duration of analgesia was longer in the MKG group (27.2 +/- 8 h versus 16.4 +/- 10 h; P < 0.05). In the MKG group, the visual analog scale (VAS) score began to be significantly lower from 14 h at rest and 12 h

2003 Anesthesia and analgesia Controlled trial quality: uncertain

6004. Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care. (Abstract)

Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care. To compare propofol with ketamine sedation delivered by pediatric intensivists during painful procedures in the pediatric critical care department (PCCD).Prospective 15-month study.An 18-bed multidisciplinary, university-affiliated PCCD.All children were randomized to the propofol or ketamine protocol according to prescheduled procedure dates. Propofol (...) was delivered by continuous infusion after a loading bolus dose and a minidose of lidocaine (PL). Ketamine was given as a bolus injection together with midazolam and fentanyl (KMF). Repeated bolus doses of both drugs were given to achieve the desired level of anesthesia. The studied variables included procedures performed, anesthetic drug doses, procedure and recovery durations, and side effect occurrence. The patient's parents, PCCD nurse and resident physician, pediatric intensivist, and the physician

2002 Critical care medicine Controlled trial quality: uncertain

6005. Ketamine attenuates neutrophil activation after cardiopulmonary bypass. (Abstract)

Ketamine attenuates neutrophil activation after cardiopulmonary bypass. Surgery is associated with activation of neutrophils and their influx into affected tissue. The pathogenic role of superoxide production generated by activated neutrophils has been documented repeatedly. Ketamine suppresses neutrophil oxygen radical production in vitro. In the present study, we compared the effect of adding small-dose ketamine to opioids during the induction of general anesthesia on superoxide production (...) by neutrophils after coronary artery bypass grafting (CABG). Thirty-five patients undergoing elective CABG were randomized to one of two groups and prospectively studied in a double-blinded manner. The patients received either ketamine 0.25 mg/kg or a similar volume of saline in addition to large-dose fentanyl anesthesia. Blood samples were drawn before the operation, immediately after cardiopulmonary bypass, 24 and 48 postoperative h, and on postoperative Days 3-6. Functional capacity of neutrophils

2002 Anesthesia and analgesia Controlled trial quality: uncertain

6006. Use of low doses of ketamine administered by constant rate infusion as an adjunct for postoperative analgesia in dogs. (Abstract)

Use of low doses of ketamine administered by constant rate infusion as an adjunct for postoperative analgesia in dogs. To compare indicators of postoperative pain and behavior in dogs with and without a low-dose ketamine infusion added to usual perioperative management.Prospective, randomized, blinded clinical study.27 dogs undergoing forelimb amputation.Dogs were anesthetized with glycopyrrolate, morphine, propofol, and isoflurane. Thirteen dogs were treated with ketamine IV, as follows: 0.5 (...) evaluated their dogs' appetite, activity, and wound soreness on postoperative days 2, 3, and 4.Dogs that received ketamine infusions had significantly lower pain scores 12 and 18 hours after surgery and were significantly more active on postoperative day 3 than dogs that received saline solution infusions.Results suggest that perioperative administration of low doses of ketamine to dogs may augment analgesia and comfort in the postoperative surgical period.

2002 Journal of the American Veterinary Medical Association Controlled trial quality: uncertain

6007. Ketamine and fMRI BOLD signal: distinguishing between effects mediated by change in blood flow versus change in cognitive state. Full Text available with Trip Pro

Ketamine and fMRI BOLD signal: distinguishing between effects mediated by change in blood flow versus change in cognitive state. No human fMRI studies have examined ketamine effects on the BOLD signal change associated with cognitive task performance. We wished to distinguish between effects on 1) cerebral blood flow, with resultant change in BOLD signal; and 2) cognition and neural mechanisms underlying BOLD signal change associated with task performance. Eight right-handed men (mean age 28.75 (...) years) received ketamine or saline i.v. in a randomized, double-blind manner (bolus 0.23 mg/kg; 0.5 mg/kg over 45 min to a maximum 1 hr). Subjects viewed 10 alternating 30-sec blocks of faces with neutral expressions and a fixation cross and discriminated gender of faces. Gradient echo echoplanar images were acquired on a GE Signa 1.5 T Neurovascular system. One hundred T2-weighted images depicting BOLD contrast were acquired over 5 min (for each task) at each of 14 near-axial noncontiguous 7-mm

2003 Human brain mapping Controlled trial quality: uncertain

6008. A single infusion of intravenous ketamine improves pain relief in patients with critical limb ischaemia: results of a double blind randomised controlled trial. (Abstract)

A single infusion of intravenous ketamine improves pain relief in patients with critical limb ischaemia: results of a double blind randomised controlled trial. We report the first double blind randomised controlled trial of regular opioids and an infusion of low dose (0.6 mg/kg) intravenous ketamine compared with opioids and placebo in patients with allodynia, hyperalgesia and hyperpathia secondary to critical limb ischaemia. Thirty-five patients completed the study, 18 received regular opioids (...) plus ketamine, while 17 received regular opioids plus placebo. Using the Brief Pain Inventory, the % pain relief that the patients in the ketamine group attributed to their medication improved significantly from 50% immediately pre-infusion to 65% 24 h post-infusion and 69% 5 days post infusion. Over the same period, the pain relief achieved by the placebo group rose from 58% pre-infusion to 56% 24 h post infusion and then 50% relief 5 days later. This was statistically significant (P<0.05) using

2002 Pain Controlled trial quality: predicted high

6009. Infusion of guaifenesin, ketamine, and medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane alone for anesthesia of horses. (Abstract)

Infusion of guaifenesin, ketamine, and medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane alone for anesthesia of horses. To evaluate effects of infusion of guaifenesin, ketamine, and medetomidine in combination with inhalation of sevoflurane versus inhalation of sevoflurane alone for anesthesia of horses.Randomized clinical trial.40 horses.Horses were premedicated with xylazine and anesthetized with diazepam and ketamine. Anesthesia was maintained (...) by infusion of guaifenesin, ketamine, and medetomidine and inhalation of sevoflurane (20 horses) or by inhalation of sevoflurane (20 horses). A surgical plane of anesthesia was maintained by controlling the inhaled concentration of sevoflurane. Sodium pentothal was administered as necessary to prevent movement in response to surgical stimulation. Hypotension was treated with dobutamine; hypoxemia and hypercarbia were treated with intermittent positive-pressure ventilation. The quality of anesthetic

2002 Journal of the American Veterinary Medical Association Controlled trial quality: uncertain

6010. Propofol-ketamine versus propofol-fentanyl for outpatient laparoscopy: comparison of postoperative nausea, emesis, analgesia, and recovery. (Abstract)

Propofol-ketamine versus propofol-fentanyl for outpatient laparoscopy: comparison of postoperative nausea, emesis, analgesia, and recovery. To compare postoperative nausea, emesis, analgesia, and recovery between propofol-ketamine and propofol-fentanyl in outpatient laparoscopic tubal ligations with general anesthesia.Prospective, randomized, blinded study.Tertiary-care women's hospital.120 ASA physical status I and II ambulatory patients scheduled for elective laparoscopic tubal (...) ligation.Patients were randomized to two groups to receive either ketamine (1-1.5 mg/kg) or fentanyl (3-5 microg/kg).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

2002 Journal of clinical anesthesia Controlled trial quality: uncertain

6011. Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up. (Abstract)

Ketamine psychotherapy for heroin addiction: immediate effects and two-year follow-up. Seventy detoxified heroin-addicted patients were randomly assigned to one of two groups receiving ketamine psychotherapy (KPT) involving two different doses of ketamine. The patients of the experimental group received existentially oriented psychotherapy in combination with a hallucinogenic ("psychedelic") dose of ketamine (2.0 mg/kg im). The patients of the control group received the same psychotherapy (...) combined with a low, non-hallucinogenic (non-psychedelic), dose of ketamine (0.2 mg/kg im). Both the psychotherapist and patient were blind to the dose of ketamine. The therapy included preparation for the ketamine session, the ketamine session itself, and the post session psychotherapy aimed to help patients to integrate insights from their ketamine session into everyday life. The results of this double blind randomized clinical trial of KPT for heroin addiction showed that high dose (2.0 mg/kg) KPT

2002 Journal of substance abuse treatment Controlled trial quality: uncertain

6012. [Recovery from anaesthesia and incidence and intensity of postoperative nausea and vomiting following a total intravenous anaesthesia (TIVA) with S-(+)-ketamine/propofol compared to alfentanil/propofol]. (Abstract)

[Recovery from anaesthesia and incidence and intensity of postoperative nausea and vomiting following a total intravenous anaesthesia (TIVA) with S-(+)-ketamine/propofol compared to alfentanil/propofol]. Opioids contribute to postoperative nausea and vomiting (PONV). An intraoperative analgesia with S-(+)-ketamine will make opioid administration dispensable and may reduce postoperative analgesic requirements. The aim of the study was to record the incidence and intensity of PONV following (...) a total intravenous anesthesia (TIVA) with S-(+)-ketamine/propofol (K/P) or alfentanil/propofol (A/P) as well as recovery from anaesthesia.A total of 145 patients received a TIVA with K/P or A/P. Recovery time,PONV, intensity of pain and overall acceptance of the delivered anaesthesia were recorded.Recovery times were prolonged in the K/P group. Both groups had a comparable incidence of PONV (26% and 22% for K/P vs A/P, respectively), the intensity was low in both groups with a VAS of <6/100 mm at all

2002 Der Anaesthesist Controlled trial quality: uncertain

6013. Assessment of the effect of dextromethorphan and ketamine on the acute nociceptive threshold and wind-up of the second pain response in healthy male volunteers. Full Text available with Trip Pro

Assessment of the effect of dextromethorphan and ketamine on the acute nociceptive threshold and wind-up of the second pain response in healthy male volunteers. The aim of this study was to assess the efficacy of dextromethorphan and ketamine relative to placebo on the acute nociceptive threshold and wind-up of second pain response in healthy male volunteers.The trial was a randomized, double-blind, placebo-controlled, three period crossover, double dummy design in 12 healthy male volunteers (...) . During each of the three periods (which were separated by a 1 week washout period) each volunteer received either a single oral dose of 0.7 mg kg(-1) dextromethorphan and placebo to ketamine, or placebo to dextromethorphan followed by a single intravenous injection of 0.375 mg kg(-1) ketamine, or placebo to both dextromethorphan and ketamine. The trial did not schedule administration of both ketamine and dextromethorphan together. Acute nociceptive thresholds and wind-up of second pain were measured

2002 British journal of clinical pharmacology Controlled trial quality: predicted high

6014. The effect of intravenous administration of variable-dose flumazenil after fixed-dose ketamine and midazolam in healthy cats. (Abstract)

The effect of intravenous administration of variable-dose flumazenil after fixed-dose ketamine and midazolam in healthy cats. The effects of intravenous administration of variable-dose flumazenil (0, 0.001, 0.005, 0.01, and 0.1 mg/kg) after ketamine (3 mg/kg) and midazolam (0.0 and 0.5 mg/kg) were studied in 18 healthy unmedicated cats from time of administration until full recovery. End-points were chosen to determine whether flumazenil shortened the recovery period and/or modified behaviors (...) , sternal recumbency with head up and walking with ataxia) than any of the other treatment groups that received midazolam. For complete recovery, flumazenil did decrease the proportion of the cats that was sedated, but did not shorten the time to walking without ataxia. Based on this study, the administration of flumazenil in veterinary practice, at the doses studied, to shorten and/or improve the recovery from ketamine and midazolam in healthy cats cannot be recommended.

2002 Journal of veterinary pharmacology and therapeutics Controlled trial quality: uncertain

6015. Supplementing desflurane-remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requirements. (Abstract)

Supplementing desflurane-remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requirements. Relative large-dose intraoperative remifentanil could lead to the need for more postoperative analgesics. Intraoperative N-methyl-D-aspartate receptor antagonists, such as ketamine, decrease postoperative opioid use. We therefore tested the hypothesis that intraoperative small-dose ketamine improves postoperative analgesia after major abdominal surgery with remifentanil (...) -based anesthesia. Fifty patients undergoing abdominal surgery under remifentanil-based anesthesia were randomly assigned to intraoperative ketamine or saline (control) supplementation. The initial ketamine dose of 0.15 mg/kg was followed by 2 microg. kg(-1). min(-1). In both groups, desflurane was kept constant at 0.5 minimum alveolar anesthetic concentration without N(2)O, and a remifentanil infusion was titrated to autonomic responses. All patients were given 0.15 mg/kg of morphine 30 min before

2002 Anesthesia and analgesia Controlled trial quality: uncertain

6016. Small-dose ketamine improves the postoperative state of depressed patients. (Abstract)

Small-dose ketamine improves the postoperative state of depressed patients. We investigated whether ketamine is suitable for depressed patients who had undergone orthopedic surgery. We studied 70 patients with major depression and 25 patients as the control (Group C). The depressed patients were divided randomly into two groups; patients in Group A (n = 35) were induced with propofol, fentanyl, and ketamine and patients in Group B (n = 35) were induced with propofol and fentanyl, and all (...) tendencies, somatic anxiety, and hypochondriasis significantly decreased in Group A as compared with Group B. Postoperative pain scores in Group A at 8 and 16 h after the end of anesthesia were 26.6 +/- 8.7 and 24.9 +/- 8.2, respectively, which were significantly (P < 0.05) lower than 34.3 +/- 12.0 and 31.1 +/- 8.8 in Group B. In conclusion, small-dose ketamine improved the postoperative depressive state and relieved postoperative pain in depressed patients.NMDA receptor antagonists are reported

2002 Anesthesia and analgesia Controlled trial quality: uncertain

6017. A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery. (Abstract)

A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery. We tested whether, after major abdominal surgery, the addition of magnesium or ketamine to tramadol for intravenous (IV) patient-controlled analgesia (PCA) improved analgesia and lowered pain scores, compared to a PCA containing only tramadol.Sixty-six patients were allocated randomly to receive a PCA with tramadol alone (T (...) ), tramadol plus magnesium (TM) or tramadol plus ketamin (TK), in a double-blind randomized study. Postoperative analgesia was started when the verbal rating scale (VRS) score was 2 or more. Following a loading dose of the study solution (which contained 1 mg/kg tramadol), a background infusion of 0.4 mg/kg/h was started. Patients were allowed to use bolus doses of 0.2 mg/kg every 20 min without a time limit. Discomfort, sedation, pain scores, total and bolus PCA tramadol consumption, and side-effects

2002 Acta Anaesthesiologica Scandinavica Controlled trial quality: uncertain

6018. Patient-controlled bupivacaine wound instillation following cesarean section: the lack of efficacy of adjuvant ketamine. (Abstract)

Patient-controlled bupivacaine wound instillation following cesarean section: the lack of efficacy of adjuvant ketamine. To assess the analgesic efficacy of ketamine when administered as an adjuvant to bupivacaine for patient-controlled wound instillation following cesarean section.Prospective, randomized, double-blind study.Large referral hospital.50 term parturients undergoing cesarean section.In all cases, a standard spinal anesthetic was administered. On completion of the surgery (...) , a multihole 20 G epidural catheter (B. Braun, Melsungen, Germany) was placed above the fascia such that the tip was sited at the point which demarcated 50% of the length of the surgical wound. Thereafter, the catheter was connected to a patient-controlled drug delivery device. The device was filled with either 0.125% bupivacaine (bupivacaine group) or 0.125% bupivacaine and ketamine (1 mg/mL) (bupivacaine-ketamine group). Postoperatively, wound instillation was performed via the patient-controlled

2002 Journal of clinical anesthesia Controlled trial quality: uncertain

6019. A comparison of two different doses of ketamine with midazolam and midazolam alone as oral preanaesthetic medication on recovery after sevoflurane anaesthesia in children. (Abstract)

A comparison of two different doses of ketamine with midazolam and midazolam alone as oral preanaesthetic medication on recovery after sevoflurane anaesthesia in children. This investigation prospectively evaluated the effect of oral premedication of two different doses of ketamine with midazolam and midazolam alone on the recovery of children after sevoflurane anaesthesia.In a randomized, double-blind study, 79 children (aged 1-8 years, ASA physical status I or II) were assigned to receive one (...) of three premedications in a volume of 0.5 ml x kg(-1): group 1 received midazolam 0.5 mg x kg(-1) (MD); group 2 received midazolam 0.5 mg x kg(-1) with ketamine 1.8 mg x kg(-1) (MK-1); and group 3 received midazolam 0.5 mg x kg(-1) with ketamine 3 mg x kg(-1) (MK-2). The reactions of the children during administration were noted. Anaesthesia was induced by facemask with incremental sevoflurane administration. All children received alfentanil (15 micro g x kg(-1)). Tracheal intubation was facilitated

2002 Paediatric anaesthesia Controlled trial quality: uncertain

6020. Differential modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans. (Abstract)

Differential modulation of remifentanil-induced analgesia and postinfusion hyperalgesia by S-ketamine and clonidine in humans. Experimental studies and clinical observations suggest a possible role for opioids to induce pain and hyperalgesia on withdrawal. The authors used a new experimental pain model in human skin to determine the time course of analgesic and hyperalgesic effects of the mu-receptor agonist remifentanil alone or in combination with the N-methyl-D-aspartate-receptor antagonist (...) S-ketamine or the alpha(2)-receptor agonist clonidine.Thirteen volunteers were enrolled in this randomized, double-blind, placebo-controlled study. Transcutaneous electrical stimulation at a high current density (2 Hz, 67.3 +/- 16.8 mA, mean +/- SD) induced acute pain (numerical 11-point rating scale: 5-6 out of 10) and stable areas of mechanical hyperalgesia to punctate stimuli and touch (allodynia). The magnitude of pain and area of hyperalgesia were assessed before, during, and after drug

2003 Anesthesiology Controlled trial quality: uncertain

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