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61. Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial Full Text available with Trip Pro

Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial Subanesthetic ketamine doses have been shown to have rapid yet transient antidepressant effects in patients with treatment-resistant depression, which may be prolonged by repeated administration. The purpose of this study was to evaluate the antidepressant effects of a single ketamine infusion, a series of repeated ketamine infusions, and prolongation of response (...) with maintenance infusions.Forty-one participants with treatment-resistant depression completed a single-site randomized double-blind crossover comparison of single infusions of ketamine and midazolam (an active placebo control). After relapse of depressive symptoms, participants received a course of six open-label ketamine infusions administered thrice weekly over 2 weeks. Responders, classified as those participants who had a ≥50% decrease in their scores on the Montgomery-Åsberg Depression Rating Scale

2019 EvidenceUpdates

62. Effects of low-dose ketamine infusion on remifentanil-induced acute opioid tolerance and the inflammatory response in patients undergoing orthognathic surgery Full Text available with Trip Pro

Effects of low-dose ketamine infusion on remifentanil-induced acute opioid tolerance and the inflammatory response in patients undergoing orthognathic surgery Remifentanil is associated with acute opioid tolerance that can lead to increased postoperative consumption of opioid analgesics. The purpose of this study was to determine whether a low dose of ketamine prevents remifentanil-induced acute opioid tolerance and affects the neutrophil-lymphocyte ratio (NLR), a newly recognized biomarker (...) of inflammation.Forty patients undergoing orthognathic surgery were enrolled in this prospective, randomized, double-blind study and randomly assigned to intraoperative administration of one of the following anesthetic regimens: high-dose remifentanil (0.6 µg/kg/minute); low-dose remifentanil (0.2 µg/kg/minute); or high-dose remifentanil with ketamine (remifentanil 0.6 µg/kg/minute with 0.5 mg/kg ketamine just after induction followed by an intraoperative infusion of ketamine 5 µg/kg/minute until wound closure

2019 EvidenceUpdates

63. Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial (Abstract)

Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial Kidney stones are a fairly common problem that manifests itself as symptoms of acute abdominal and flank pains in patients presenting to emergency departments.The present study was conducted to compare the analgesic effect of intravenous fentanyl with that of intranasal ketamine in renal colic patients.One mg/kg of intranasal ketamine was administered (...) in the first group, and one μg/kg of intravenous fentanyl in the second group. The pain severity was measured in the patients in terms of a visual analogue scale (VAS) score at the beginning of the study and at minutes 5, 15 and 30, and the medication side-effects were evaluated and recorded.A total of 130 patients were ultimately assessed in two groups of 65. In the ketamine group, the mean severity of pain was 8.72 ± 1.52 at the beginning of the study (P < 0.001), 5.5 ± 2.97 at minute 5 (P < 0.001

2019 EvidenceUpdates

64. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery Full Text available with Trip Pro

Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery Persistent postsurgical pain is common and affects quality of life. The hypothesis was that use of pregabalin and ketamine would prevent persistent pain after cardiac surgery.This randomized, double-blind, placebo-controlled trial was undertaken at two cardiac surgery centers in the United Kingdom. Adults without chronic pain and undergoing any elective cardiac surgery patients via sternotomy (...) were randomly assigned to receive either usual care, pregabalin (150 mg preoperatively and twice daily for 14 postoperative days) alone, or pregabalin in combination with a 48-h postoperative infusion of intravenous ketamine at 0.1 mg · kg · h. The primary endpoints were prevalence of clinically significant pain at 3 and 6 months after surgery, defined as a pain score on the numeric rating scale of 4 or higher (out of 10) after a functional assessment of three maximal coughs. The secondary outcomes

2019 EvidenceUpdates

65. Ketamine infusion for treatment-resistant bipolar depression

Ketamine infusion for treatment-resistant bipolar depression Ketamine infusion for treatment-resistant bipolar depression Ketamine infusion for treatment-resistant bipolar depression HAYES, Inc Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation HAYES, Inc. Ketamine infusion for treatment-resistant bipolar depression. Lansdale: HAYES, Inc. Healthcare Technology (...) Brief Publication. 2017 Authors' conclusions Health Problem: Bipolar disorder is a chronic illness characterized by alternating periods of profound depression and excessively elevated or irritable mood (mania). These episodes of extreme mood are interspersed by periods of relatively normal mood. Bipolar disorder is a severely impairing illness associated with unemployment, decreased productivity, and excess mortality. Technology Description: Ketamine therapy for bipolar disorder often involves

2017 Health Technology Assessment (HTA) Database.

66. Ketamine as primary therapy for treatment-resistant unipolar depression or posttraumatic stress disorder

Ketamine as primary therapy for treatment-resistant unipolar depression or posttraumatic stress disorder Ketamine as primary therapy for treatment-resistant unipolar depression or posttraumatic stress disorder Ketamine as primary therapy for treatment-resistant unipolar depression or posttraumatic stress disorder HAYES, Inc Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database (...) . Citation HAYES, Inc. Ketamine as primary therapy for treatment-resistant unipolar depression or posttraumatic stress disorder. Lansdale: HAYES, Inc. Directory Publication. 2017 Authors' conclusions Health Problem: Treatment-resistant depression (TRD) is typically defined as depression that does not respond to at least 2 attempts at treatment of adequate duration with appropriate doses of antidepressants, but there is no official consensus definition. Posttraumatic stress disorder (PTSD) is an anxiety

2017 Health Technology Assessment (HTA) Database.

67. Ketamine as an adjunct to electroconvulsive therapy for treatment-resistant depression

Ketamine as an adjunct to electroconvulsive therapy for treatment-resistant depression Ketamine as an adjunct to electroconvulsive therapy for treatment-resistant depression Ketamine as an adjunct to electroconvulsive therapy for treatment-resistant depression HAYES, Inc Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation HAYES, Inc. Ketamine as an adjunct (...) Description: Intravenous injection (IV) of ketamine hydrochloride as an adjunct to electroconvulsive therapy (ECT) is intended to reduce symptoms of depression more rapidly and to a greater extent than ECT alone in patients who have TRD. Controversy: Early evidence for the antidepressant effect of ketamine came from uncontrolled studies and TRD may have diverse causes and poor response rates that make it difficult to demonstrate whether or not ketamine treatment is effective. Key Questions: Does ketamine

2017 Health Technology Assessment (HTA) Database.

68. Ketamine disrupts neuromodulatory control of glutamatergic synaptic transmission. Full Text available with Trip Pro

Ketamine disrupts neuromodulatory control of glutamatergic synaptic transmission. A growing body of literature has demonstrated the potential for ketamine in the treatment of major depression. Sub-anesthetic doses produce rapid and sustained changes in depressive behavior, both in patients and rodent models, associated with reorganization of glutamatergic synapses in the prefrontal cortex (PFC). While ketamine is known to regulate N-methyl-D-aspartate (NMDA) -type glutamate receptors (NMDARs (...) ), the full complement of downstream cellular consequences for ketamine administration are not well understood. Here, we combine electrophysiology with 2-photon imaging and glutamate uncaging in acute slices of mouse PFC to further examine how ketamine alters glutamatergic synaptic transmission. We find that four hours after ketamine treatment, glutamatergic synapses themselves are not significantly affected. However, levels of the neuromodulatory Regulator of G-protein Signaling (RGS4) are dramatically

2019 PLoS ONE

69. Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation. Full Text available with Trip Pro

Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation. The optimal sedative regime that provides the greatest comfort and the lowest risk for procedural sedation in young children remains to be determined. The aim of this randomized, blinded, controlled, parallel-design trial was to evaluate the efficacy of intranasal ketamine and midazolam as the main component of the behavioral guidance (...) approach for preschoolers during dental treatment.Children under seven years of age, with caries and non-cooperative behavior, were randomized into three groups: (KMIN) intranasal ketamine and midazolam; (KMO) oral ketamine and midazolam; or (MO) oral midazolam. The dental sedation appointments were videotaped, and the videos were analyzed using the Ohio State University Behavioral Rating Scale (OSUBRS) to determine the success of the sedation in each group. Intra- and postoperative adverse events were

2019 PLoS ONE Controlled trial quality: predicted high

70. Stress-sensitive antidepressant-like effects of ketamine in the mouse forced swim test. Full Text available with Trip Pro

Stress-sensitive antidepressant-like effects of ketamine in the mouse forced swim test. Major depression is a stress-linked disease with significant morbidity and the anesthetic drug ketamine is of growing interest in the treatment of depression, since in responsive individuals a single dose has rapid (within hours) antidepressant effects that can be sustained for over a week in some instances. This combination of fast action and a therapeutic effect that lasts far beyond the drug's half-life (...) points to a unique mechanism of action. In this reverse translational study, we investigate the degree to which ketamine counteracts stress-related depression-like behavioral responses by determining whether it affects unstressed animals similarly to stressed mice. To test this, male C57BL/6J mice were given a single injection of vehicle (0.9% saline; i.p.), 10 mg/kg ketamine, or 30 mg/kg ketamine, and were tested in the forced swim test (FST) 24 hours and 7 days later, as well as in the open field

2019 PLoS ONE

71. Intranasal Ketamine Administration for Narcotic Dose Decrement in Patients Suffering from Acute Limb Trauma in Emergency Department: a Double-Blind Randomized Placebo-Controlled Trial. (Abstract)

Intranasal Ketamine Administration for Narcotic Dose Decrement in Patients Suffering from Acute Limb Trauma in Emergency Department: a Double-Blind Randomized Placebo-Controlled Trial. pain management is an important and challenging issue in emergency medicine. Despite the conduct of several studies on this topic, pain is still handled improperly in many cases.This study investigated the effectiveness of low-dose IN ketamine administration in reducing the need for opiates in patients in acute (...) pain resulting from limb injury.This randomized, double-blind, placebo-controlled trial was conducted to assess the possible effect of low-dose intranasal (IN) ketamine administration in decreasing patients' narcotic need. Patients in emergency department suffering from acute isolated limb trauma were included. One group of patients received 0.5 mg/kg intravenous morphine sulfate and 0.02 ml/kg IN ketamine. The other group received the same dose of morphine sulfate and 0.02 ml/kg IN distilled water

2018 Advanced journal of emergency medicine Controlled trial quality: uncertain

72. Propofol-Ketamine vs. Propofol-Fentanyl Combinations in Patients Undergoing Closed Reduction: A Randomized, Double-blind, Clinical Trial. (Abstract)

Propofol-Ketamine vs. Propofol-Fentanyl Combinations in Patients Undergoing Closed Reduction: A Randomized, Double-blind, Clinical Trial. Painful surgical procedures require adequate sedation and analgesia. A vast array of medications can be used for Procedural Sedation and Analgesia (PSA) in Emergency Departments (EDs).The present study was conducted to compare Propofol-Ketamine (PK) and Propofol-Fentanyl (PF) compounds in patients undergoing closed reduction in EDs.This randomized, double (...) -blind, clinical trial was conducted on 110 consecutive patients who required sedation for closed reduction. The patients were randomly divided into two groups of equal sizes. The PK group received an intravenous bolus of 1 mg/kg of propofol plus 0.5 mg/kg of ketamine, and the PF group received an intravenous bolus of 1 mg/kg of propofol plus 1 µg/kg of fentanyl. The analgesic effect and success rate were the primary outcomes under study.The PK group achieved more effective analgesia at the end

2018 Advanced journal of emergency medicine Controlled trial quality: uncertain

73. Characteristics of patients expressing an interest in ketamine treatment: results of an online survey Full Text available with Trip Pro

Characteristics of patients expressing an interest in ketamine treatment: results of an online survey Off-label ketamine treatment has shown acute antidepressant effects that offer hope for patients with therapy-resistant depression. However, its potential for integration into treatment algorithms is controversial, not least because the evidence base for maintenance treatment with repeated ketamine administration is currently weak. Ketamine is also a drug of misuse, which has raised concerns (...) regarding the target population. Little is known about which patients would seek ketamine treatment if it were more widely available.To explore some of the characteristics of the patients actively seeking ketamine treatment.An online survey containing questions about duration of current depressive episode, number of antidepressants used and other comments was completed by patients who were exploring the internet regarding the possibility of ketamine for depression.Of the 1088 people who registered

2018 BJPsych open

74. Low-dose Ketamine for Acute Pain in the Emergency Department

Low-dose Ketamine for Acute Pain in the Emergency Department BestBets: Low-dose Ketamine for Acute Pain in the Emergency Department Low-dose Ketamine for Acute Pain in the Emergency Department Report By: Colby Duncan MD - Senior EM Resident Search checked by Brad Riley MD - EM Faculty Institution: Grand Rapids Medical Education Research Partners/Michigan State University Date Submitted: 15th July 2016 Date Completed: 11th February 2017 Last Modified: 11th February 2017 Status: Green (complete (...) ) Three Part Question [In ED patients with acute pain who do not respond to conventional therapies], is the [low-dose ketamine better than morphine] at [safely and effectively reducing pain scores]? Clinical Scenario A man aged 25 years presents to the ED with a closed fracture of the right humeral head. He has severe pain around the shoulder and is allergic to opioids. He is given intravenous ketorolac and midazolam. Unfortunately, the patient's pain does not improve. A colleague recommends the use

2017 BestBETS

75. Ketamine-dexmedetomidine versus ketamine-propofol (ketofol) for procedural sedation in the pediatric population: a systematic review and meta-analysis

Ketamine-dexmedetomidine versus ketamine-propofol (ketofol) for procedural sedation in the pediatric population: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO

76. Proposal for practice guideline Low dose ketamine infusion in the management of chronic noncancer pain

Proposal for practice guideline Low dose ketamine infusion in the management of chronic noncancer pain Page 1 2016 Proposal for practice guideline Low dose ketamine infusion in the management of chronic non- cancer pain Contents Proposal for practice guideline 1 Low dose ketamine infusion in the management of chronic non-cancer pain 1 Contents 1 Executive Summary 2 Literature review 2 Literature summary: state of the science; state of the art 6 Proposal for best practice in low-dose ketamine (...) infusion in the management of patients with chronic non-cancer pain 6 Faculty of Pain Medicine Professional Documents 8 Appendix 1 11 Proposed mechanisms for the analgesic effect of ketamine 11 1. Inhibition of the N-methyl-D-aspartate (NMDA) -receptor 11 2. Intrinsic analgesic effect 11 3. Central antinociceptive effects 11 4 (a) Attentuation of acute opioid tolerance 11 4 (b) Prevention of opioid-induced hyperalgesia 11 5. Cytokine effects 11 6. Effect on depression (via BDNF) 11 Appendix 2 13

2016 Australian and New Zealand College of Anaesthetists

77. The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: Results from the Canadian Rapid Treatment Center of Excellence. (Abstract)

The effectiveness of repeated intravenous ketamine on depressive symptoms, suicidal ideation and functional disability in adults with major depressive disorder and bipolar disorder: Results from the Canadian Rapid Treatment Center of Excellence. The effectiveness, tolerability, and safety of intravenous (IV) ketamine in adults with treatment resistant depression (TRD) receiving care in real-word settings is insufficiently characterized. Herein, results from a naturalistic, retrospective study (...) are presented from a Canadian outpatient IV ketamine clinic.Adults (N = 213; Mage = 45) with Major Depressive Disorder or Bipolar Disorder, with a minimum of Stage 2 antidepressant resistance, received IV ketamine at a community-based multi-disciplinary clinic. The primary outcome measure was change from baseline to post-infusion 4 on the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16; n = 190). Secondary measures included QIDS-SR16-measured response and remission rates, changes

2020 Journal of Affective Disorders

78. Antidepressant effects of ketamine and ECT: A pilot comparison. (Abstract)

Antidepressant effects of ketamine and ECT: A pilot comparison. To compare the antidepressant effects and cognitive adverse effects of intravenous ketamine infusion and Electro-convulsive therapy (ECT) in persons with severe depressive episodes.This assessor-blinded randomized control trial included 25 patients (either sex; 18-65 years) meeting ICD-10 criteria for severe depression (bipolar or unipolar). Patients received either ECT (n = 13) or intravenous infusions of ketamine hydrochloride (...) (0.5 mg/kg over 45 min; n = 12) for six alternate day sessions over a period of two weeks. Severity of depression was assessed at baseline and on every alternate day of intervention using the Hamilton Depression Rating Scale (HDRS) and self-reported Beck Depression Inventory (BDI).Baseline socio-demographic and clinical variables including HDRS (ECT: 25.15±6.58; Ketamine: 23.33±4.05, p = 0.418) and BDI (ECT: 37.07±6.58; Ketamine: 33.33±9.29; p = 0.254) were comparable. Repeated-measures analysis

2020 Journal of Affective Disorders

79. Neurocognitive impact of ketamine treatment in major depressive disorder: A review on human and animal studies. (Abstract)

Neurocognitive impact of ketamine treatment in major depressive disorder: A review on human and animal studies. Most recent evidence support a rapid and sustained antidepressant effect of subanesthetic dose of intravenous ketamine in patients with major depressive disorder (MDD). However, clinical and animal studies investigating the effects of intravenous ketamine on specific functional domains disrupted by depression reported conflicting results. Therefore, the aim of this review (...) is to provide an overview of the recent findings exploring the cognitive effects of ketamine in depression.After a bibliographic search on PubMed, Medline and PsycInfo, we retrieved 11 original studies meeting our research criteria, 7 in humans with MDD or Treatment Resistant Disorder and 4 using rats models for depression.Overall the results showed that a) ketamine reduced activation and normalized connectivity measures of several brain regions related to depressive behaviors and reversed deficits

2020 Journal of Affective Disorders

80. Development of the Ketamine Side Effect Tool (KSET). (Abstract)

Development of the Ketamine Side Effect Tool (KSET). Currently, no specific, systematic assessment tool for the monitoring and reporting of ketamine-related side effects exists. Our aim was to develop a comprehensive Ketamine Side Effect Tool (KSET) to capture acute and longer-term side effects associated with repeated ketamine treatments.Informed by systematic review data and clinical research, we drafted a list of the most commonly reported side effects. Face and content validation were (...) is required, and is planned across multiple international sites.The structured Ketamine Side Effect Tool (KSET) was developed, with confirmation of content and face validity via a Delphi consensus process. This tool is timely, given the paucity of data regarding ketamine's safety, tolerability and abuse potential over the longer term, and its recent adoption internationally as a clinical treatment for depression. Although based on data from depression studies, the KSET has potential applicability

2020 Journal of Affective Disorders

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