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141. Antidepressant and antisuicidal effects of ketamine on the functional connectivity of prefrontal cortex-related circuits in treatment-resistant depression: A double-blind, placebo-controlled, randomized, longitudinal resting fMRI study. (PubMed)

Antidepressant and antisuicidal effects of ketamine on the functional connectivity of prefrontal cortex-related circuits in treatment-resistant depression: A double-blind, placebo-controlled, randomized, longitudinal resting fMRI study. Increasing evidence suggests that infusion of a subanesthetic dose of ketamine exerts antidepressant and antisuicidal effects in patients with treatment-resistant depression (TRD).In this investigation, we used the resting functional connectivity magnetic (...) resonance imaging (fcMRI) to determine the effects of ketamine on the functional connectivity (FC) of prefrontal cortex (PFC)-related circuits in patients with TRD.Forty-eight patients with TRD were recruited and randomly divided into three groups on the basis of ketamine infusion dose: 0.5 mg/kg (standard dose), 0.2 mg/kg (low dose), or normal saline (a placebo infusion). Resting functional MRI data and clinical data were recorded at the baseline and on the third day after ketamine infusion

2019 Journal of Affective Disorders Controlled trial quality: uncertain

142. Driving Simulator Performance After Administration of Analgesic Doses of Ketamine With Dexmedetomidine or Fentanyl. (PubMed)

Driving Simulator Performance After Administration of Analgesic Doses of Ketamine With Dexmedetomidine or Fentanyl. As a sole agent, ketamine acutely compromises driving ability; however, performance after coadministration with the adjuvant sedating agents dexmedetomidine or fentanyl is unclear.Using a randomized within-subject design, 39 participants (mean ± SD age, 28.4 ± 5.8 years) received 0.3 mg/kg bolus followed by 0.15 mg kg h infusion of ketamine (3-hour duration), in addition to either (...) (i) 0.7 μg kg h infusion of dexmedetomidine for 1.5 hours (n = 19; KET/DEX) or (ii) three 25 μg fentanyl injections for 1.5 hours (n = 20; KET/FENT). Whole blood drug concentrations were determined during ketamine only, at coadministration (KET/DEX or KET/FENT) and at 2 hours after treatment. Subjective effects were determined using a standardized visual analog scale. Driving performance was assessed at baseline and at posttreatment using a validated computerized driving simulator. Primary

2019 Journal of Clinical Psychopharmacology Controlled trial quality: uncertain

143. Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy pain following video-assisted thoracic surgery: A randomized controlled study. (PubMed)

Fentanyl-based intravenous patient-controlled analgesia with low dose of ketamine is not inferior to thoracic epidural analgesia for acute post-thoracotomy pain following video-assisted thoracic surgery: A randomized controlled study. Thoracic epidural analgesia is the preferred method for postoperative analgesia following thoracic surgery. However, intravenous patient-controlled analgesia (IVPCA) may be an effective alternative. This study was conducted because few scientific reports exist (...) comparing fentanyl-based IVPCA including a low dose of ketamine (fk-IVPCA) with thoracic patient-controlled epidural analgesia (t-PCEA) for the treatment of postoperative pain after video-assisted thoracic surgery (VATS).This prospective, and randomized study included 70 patients randomized into fk-IVPCA and t-PCEA groups. Pain at rest and during movement, successful and unsuccessful triggers after pressing the PCA device button, the need for rescue analgesia, drug-related adverse events, and patient

2019 Medicine Controlled trial quality: uncertain

144. Maintenance of antidepressant and antisuicidal effects by D-cycloserine among patients with treatment-resistant depression who responded to low-dose ketamine infusion: a double-blind randomized placebo-control study. (PubMed)

Maintenance of antidepressant and antisuicidal effects by D-cycloserine among patients with treatment-resistant depression who responded to low-dose ketamine infusion: a double-blind randomized placebo-control study. Increasing evidence supports a rapid antidepressant and antisuicidal effect of a single subanesthetic dose of ketamine infusion for treatment-resistant depression (TRD). Maintaining the initial clinical response after ketamine infusion in TRD is a crucial next-step challenge. D (...) -cycloserine (DCS), a partial agonist of the glycine co-agonist of the N-methyl-D-aspartate (NMDA) glutamate receptor, is potentially effective as a depression augmentation treatment. However, whether DCS maintains the antidepressant and antisuicidal effects of ketamine infusion remains unknown. In all, 32 patients with TRD (17 with major depression and 15 with bipolar depression) who responded to ketamine infusion with an average 17-item Hamilton Depression Rating Scale (HAMD) score of 9.47 ± 4.11

2019 Neuropsychopharmacology Controlled trial quality: uncertain

145. Intraoperative Ketamine in Total Knee Arthroplasty Does Not Decrease Pain and Narcotic Consumption: A Prospective Randomized Controlled Trial. (PubMed)

Intraoperative Ketamine in Total Knee Arthroplasty Does Not Decrease Pain and Narcotic Consumption: A Prospective Randomized Controlled Trial. Multiple studies have demonstrated that ketamine, a glutamate receptor blocker, may decrease postoperative pain in abdominal and orthopedic surgeries. However, its role with spinal anesthesia and total knee arthroplasty (TKA) remains unknown. The purpose of this study is to determine the efficacy of subanesthetic dosing of ketamine during TKA (...) on postoperative pain and narcotic consumption.In this prospective, randomized, double-blinded clinical trial, we enrolled 91 patients undergoing primary TKA with spinal anesthesia in a single institution from 2017 to 2018. Patients were randomized to receive intraoperative ketamine infusion at a rate of 6 mcg/kg/min for 75 minutes or a saline placebo. All patients received spinal anesthesia and otherwise identical surgical approaches, pain management, and rehabilitation protocols. Patient-reported visual

2019 Journal of Arthroplasty Controlled trial quality: predicted high

146. Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. (PubMed)

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 American Journal of Psychiatry Controlled trial quality: uncertain

147. Ketamine infusion for pain control in adult patients with multiple rib fractures: Results of a randomized control trial. (PubMed)

Ketamine infusion for pain control in adult patients with multiple rib fractures: Results of a randomized control trial. Rib fractures occur in up to 40% of trauma patients and are associated with increased mortality. Opiate-based pain regimens remain the cornerstone of rib fracture management; however, concerns around opioids have fostered interest in alternative analgesics. Ketamine is currently being used in lieu of opioids, but little evidence exists supporting its use within the trauma (...) population.A prospective, randomized, double-blind placebo-controlled trial of adult patients with three or more rib fractures admitted to a Level I trauma center was conducted. Exclusion criteria included age older than 64 years, Glasgow Coma Scale score less than 13, and chronic opiate use. The experimental arm received low-dose ketamine (LDK) at 2.5 μg·kg·min while the placebo cohort received an equivalent rate of 0.9% normal saline. All infusions were continued for 48 hours. The primary outcome

2019 The journal of trauma and acute care surgery Controlled trial quality: predicted high

148. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery. (PubMed)

Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery. Cardiac surgery is associated with a significant rate of chronic postoperative painFew proven strategies exist to reduce chronic postoperative pain WHAT THIS ARTICLE TELLS US THAT IS NEW: The administration of pregabalin (14 days) with or without ketamine (2 days) postoperatively reduced the prevalence of pain at 3 and 6 monthsSide effects from pregabalin and ketamine administration were (...) generally mild BACKGROUND:: 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

2019 Anesthesiology Controlled trial quality: predicted high

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

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 American Journal of Emergency Medicine Controlled trial quality: uncertain

150. A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial. (PubMed)

A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial. Research has suggested that subanesthetic doses of ketamine may work to improve cocaine-related vulnerabilities and facilitate efforts at behavioral modification. The purpose of this trial was to test whether a single ketamine infusion improved treatment outcomes in cocaine-dependent adults engaged in mindfulness-based relapse prevention.Fifty-five cocaine (...) -dependent individuals were randomly assigned to receive a 40-minute intravenous infusion of ketamine (0.5 mg/kg) or midazolam (the control condition) during a 5-day inpatient stay, during which they also initiated a 5-week course of mindfulness-based relapse prevention. Cocaine use was assessed through self-report and urine toxicology. The primary outcomes were end-of-study abstinence and time to relapse (defined as first use or dropout).Overall, 48.2% of individuals in the ketamine group maintained

2019 American Journal of Psychiatry Controlled trial quality: predicted high

151. Lithium continuation therapy following ketamine in patients with treatment resistant unipolar depression: a randomized controlled trial. (PubMed)

Lithium continuation therapy following ketamine in patients with treatment resistant unipolar depression: a randomized controlled trial. The N-methyl-D-aspartate (NMDA) receptor antagonist ketamine is associated with rapid but transient antidepressant effects in patients with treatment resistant unipolar depression (TRD). Based on work suggesting that ketamine and lithium may share overlapping mechanisms of action, we tested lithium compared to placebo as a continuation strategy following (...) ketamine in subjects with TRD. Participants who met all eligibility criteria and showed at least an initial partial response to a single intravenous infusion of ketamine 0.5 mg/kg were randomized under double-blind conditions to lithium or matching placebo before receiving an additional three infusions of ketamine. Subsequent to the ketamine treatments, participants remained on lithium or placebo during a double-blind continuation phase. The primary study outcome was depression severity as measured

2019 Neuropsychopharmacology Controlled trial quality: predicted high

152. Comments on the paper by Nielsen et al. entitled "Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery: A randomized clinical trial of opioid-dependent patients". (PubMed)

Comments on the paper by Nielsen et al. entitled "Intraoperative S-ketamine for the reduction of opioid consumption and pain one year after spine surgery: A randomized clinical trial of opioid-dependent patients". After reading the article(Nielsen et al., 2019) presented in the latest issue, we reviewed another related article(Nielsen et al., 2017) published by the same author in 2017. The two articles were based on the same clinical trial (NCT02085577) assessing the effect of intraoperative (...) ketamine on opioid consumption and pain after spine surgery in opioid-dependent patients. In the earlier article, authors found that morphine consumption, both perioperatively and at 6 months after surgery, was reduced in the ketamine group compared with the placebo group. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.

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2019 European Journal of Pain Controlled trial quality: uncertain

153. Challenges in Testing Intranasal Ketamine in Obsessive-Compulsive Disorder. (PubMed)

Challenges in Testing Intranasal Ketamine in Obsessive-Compulsive Disorder. 28448699 2019 01 04 2019 01 04 1555-2101 78 4 2017 04 The Journal of clinical psychiatry J Clin Psychiatry Challenges in Testing Intranasal Ketamine in Obsessive-Compulsive Disorder. 466-467 10.4088/JCP.16cr11234 Rodriguez Carolyn I CI cr2163@stanford.edu. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA. Veterans Affairs Palo Alto Health Care System, Palo Alto, California (...) States J Clin Psychiatry 7801243 0160-6689 0 Excitatory Amino Acid Antagonists 690G0D6V8H Ketamine IM Administration, Intranasal Adolescent Adult Drug Administration Schedule Excitatory Amino Acid Antagonists administration & dosage therapeutic use Female Humans Ketamine administration & dosage therapeutic use Male Middle Aged Obsessive-Compulsive Disorder drug therapy Treatment Outcome Young Adult 2017 4 28 6 0 2017 4 28 6 0 2019 1 5 6 0 ppublish 28448699 10.4088/JCP.16cr11234

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2019 The Journal of clinical psychiatry Controlled trial quality: uncertain

154. Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain. (PubMed)

Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain. Pain which persists after thoracotomy is well recognized, and activation of the N-methyl-d-aspartate (NMDA) receptor could be a contributing factor. This study sought to establish whether ketamine given peri-operatively could reduce persistent post-surgical pain.Double-blind, randomized, placebo-controlled trial comparing low-dose intravenous ketamine and saline placebo.Seventy patients undergoing thoracotomy (...) were randomized to receive either intravenous ketamine (0.1 mg kg-1  hr-1 ) or saline placebo for 96 hr, starting 10 min prior to surgery. A bolus dose of 0.1 mg/kg of ketamine/placebo was given prior to starting the infusion. Post-operative analgesia consisted of either an epidural infusion or patient-controlled analgesia (PCA), +/- a paravertebral infusion of local anaesthetic. Pain scores and opioid consumption were collected at 24 and 48 hr after surgery. Patients completed numeric pain scores

2019 European Journal of Pain Controlled trial quality: predicted high

155. Premedication With Midazolam or Haloperidol to Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double-Blind Clinical Trial. (PubMed)

Premedication With Midazolam or Haloperidol to Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double-Blind Clinical Trial. We evaluate the effect of midazolam and haloperidol premedication for reducing ketamine-induced recovery agitation in adult patients undergoing procedural sedation. We also compare physician satisfaction and recovery time.We randomized emergency department patients older than 18 years who needed procedural sedation to receive (...) 1 of the following 3 interventions in double-blind fashion 5 minutes before receiving intravenous ketamine at 1 mg/kg: intravenous distilled water, intravenous midazolam at 0.05 mg/kg, or intravenous haloperidol at 5 mg. Our main study outcomes were recovery agitation as assessed by the maximum observed Pittsburgh Agitation Scale score and by the Richmond Agitation-Sedation Scale score at 5, 15, and 30 minutes after ketamine administration. Our secondary outcomes were clinician satisfaction

2019 Annals of Emergency Medicine Controlled trial quality: predicted high

156. Reduced auditory evoked gamma-band response and schizophrenia-like clinical symptoms under subanesthetic ketamine. (PubMed)

Reduced auditory evoked gamma-band response and schizophrenia-like clinical symptoms under subanesthetic ketamine. Abnormal gamma-band oscillations (GBO) have been frequently associated with the pathophysiology of schizophrenia. GBO are modulated by glutamate, a neurotransmitter, which is continuously discussed to shape the complex symptom spectrum in schizophrenia. The current study examined the effects of ketamine, a glutamate N-methyl-D-aspartate receptor (NMDAR) antagonist, on the auditory (...) -evoked gamma-band response (aeGBR) and psychopathological outcomes in healthy volunteers to investigate neuronal mechanisms of psychotic behavior. In a placebo-controlled, randomized crossover design, the aeGBR power, phase-locking factor (PLF) during a choice reaction task, the Positive and Negative Syndrome Scale (PANSS) and the Altered State of Consciousness (5D-ASC) Rating Scale were assessed in 25 healthy subjects. Ketamine was applied in a subanaesthetic dose. Low-resolution brain

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2019 Neuropsychopharmacology Controlled trial quality: uncertain

157. FentAnyl or placebo with KeTamine for emergency department rapid sequence intubation: The FAKT study protocol. (PubMed)

FentAnyl or placebo with KeTamine for emergency department rapid sequence intubation: The FAKT study protocol. Some critically ill patients require rapid sequence intubation in the emergency department, and ketamine is one sedative agent employed, due to its relative haemodynamic stability. Tachycardia and hypertension are frequent side effects, and in less stable patients, shock can be unmasked or exacerbated. The use of fentanyl as a co-induction agent may lead to a smoother haemodynamic (...) profile post-induction, which may lead to reduced mortality in this critically ill cohort. This randomised controlled trial aims to compare the effect of administering fentanyl vs placebo in a standardised induction regimen with ketamine and rocuronium on (a) the percentage of patients in each group with a systolic blood pressure outside the range of 100-150 mm Hg within 10 minutes of induction, (b) the laryngoscopic view, and (c) 30-day mortality.Three hundred patients requiring rapid sequence

2019 Acta Anaesthesiologica Scandinavica Controlled trial quality: predicted high

158. Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. (PubMed)

Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention (...) of postoperative delirium in older adults.The Prevention of Delirium and Complications Associated with Surgical Treatments [PODCAST] study is a multicentre, international randomised trial that enrolled adults older than 60 years undergoing major cardiac and non-cardiac surgery under general anaesthesia. Using a computer-generated randomisation sequence we randomly assigned patients to one of three groups in blocks of 15 to receive placebo (normal saline), low-dose ketamine (0·5 mg/kg), or high dose ketamine (1

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2017 Lancet Controlled trial quality: predicted high

159. Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies. (PubMed)

Analgesic efficacy and safety of ketamine after total knee or hip arthroplasty: a meta-analysis of randomised placebo-controlled studies. To examine the analgesic efficacy and safety of ketamine after total knee or hip arthroplasty.Systematic review and meta-analysis.PubMed, EMBASE and Cochrane Library from inception to 22 May 2019.Randomised controlled trials comparing the efficacy and safety of ketamine with placebo for postoperative pain relief in patients undergoing total knee or hip (...) arthroplasty.Data (ie, pain intensity, morphine consumption, gastrointestinal and psychotic adverse effects) were extracted by two reviewers independently. The Cochrane Collaboration's recommended tool was used to determine the methodological quality of included studies.A total of 10 studies were included. One of them was rated as low quality. Compared with placebo, intravenous ketamine was effective for pain relief during 0-8-hour (weighted mean difference (WMD) -1.21, 95% CI -1.45 to -0.98, p<0.001; three

2019 BMJ open

160. Ketamine for chronic depression: two cautionary tales (PubMed)

Ketamine for chronic depression: two cautionary tales A growing body of literature has shown the effectiveness of ketamine for treating chronic depression. How long the beneficial effects of repeated ketamine last once infusions are stopped, however, remains largely unknown. Understanding the challenges that ensue after ketamine cessation can help clinicians optimally guide patients who opt for ketamine treatment and minimize the associated risks. In this commentary, we discuss some unexpected (...) data gathered from participants of a pilot study on the effects of adjunctive ketamine infusion for resistant depression.© 2019 Joule Inc. or its licensors

2019 Journal of Psychiatry & Neuroscience

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