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Ketamine

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161. Topical Pharyngeal Lidocaine Reduces Respiratory Adverse Events During Upper Gastrointestinal Endoscopies Under Ketamine Sedation in Children. (Abstract)

Topical Pharyngeal Lidocaine Reduces Respiratory Adverse Events During Upper Gastrointestinal Endoscopies Under Ketamine Sedation in Children. Upper gastrointestinal endoscopies (UGEs) performed under ketamine sedation may increase the risk of respiratory adverse events (RAEs) due to pharyngeal stimulation. Topical lidocaine prevents general anesthesia-induced laryngospasm.Our objective was to determine whether topical lidocaine may reduce the incidence of RAEs induced by pharyngeal stimulation (...) in UGEs performed on children sedated with ketamine.We conducted a single-center prospective study. We included every patient admitted for an elective diagnostic UGE under ketamine sedation who received lidocaine prior to the technique. Patients requiring any other medication were excluded. Our main outcome measure was the number of desaturation episodes. We then compared these results with those obtained in an historic group who did not receive topical lidocaine, in which we registered a total of 54

2019 Paediatric Drugs

162. Challenges in Testing Intranasal Ketamine in Obsessive-Compulsive Disorder. Full Text available with Trip Pro

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

2019 The Journal of clinical psychiatry Controlled trial quality: uncertain

163. Lithium continuation therapy following ketamine in patients with treatment resistant unipolar depression: a randomized controlled trial. Full Text available with Trip Pro

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

164. 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". Full Text available with Trip Pro

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.

2019 European Journal of Pain Controlled trial quality: uncertain

165. Massive Iatrogenic Pediatric Ketamine Overdose With Serial Levels and Minimal Morbidity. (Abstract)

Massive Iatrogenic Pediatric Ketamine Overdose With Serial Levels and Minimal Morbidity. Ketamine is a dissociative anesthetic commonly used for procedural sedation owing to its perceived favorable safety profile. Despite its frequent use, overdoses of ketamine are rarely reported, and no cases with serum levels of ketamine or its metabolite have previously been reported. We report a case of an iatrogenic pediatric ketamine 20 mg/kg intramuscular overdose with serial ketamine and norketamine

2019 Pediatric Emergency Care

166. Assessment of Ketamine Adult Anesthetic Doses in Pediatrics using Pharmacokinetic Modeling and Simulations. (Abstract)

Assessment of Ketamine Adult Anesthetic Doses in Pediatrics using Pharmacokinetic Modeling and Simulations. Although few studies have used ketamine for induction and maintenance of pediatric anesthesia, official dosage recommendations are lacking. This study evaluates the outcomes of adult anesthetic doses in a pediatric population through pharmacokinetic modeling and computer simulations in an attempt to recommend an adequate ketamine dosing regimen. Ketamine plasma concentration-time data (...) in 19 children (age 8 months to 16 years; weight 5.5 to 67 kg) were analyzed according to a non-compartmental pharmacokinetic approach. The relationship between pharmacokinetic parameters and demographic covariates was mathematically characterized. A one-compartment open model was implemented to simulate the plasma profile following administration of 1-4.5 mg/kg IV bolus dose and 0.1-0.5 mg/kg/min continuous infusion of ketamine and to predict anesthesia onset and offset. Pharmacokinetic parameters

2019 Pharmacotherapy

167. Psychiatric Outcomes of Patients with Severe Agitation Following Administration of Prehospital Ketamine. (Abstract)

Psychiatric Outcomes of Patients with Severe Agitation Following Administration of Prehospital Ketamine. Ketamine is an emerging drug used in the management of undifferentiated, severe agitation in the prehospital setting. However, prior work has indicated that ketamine may exacerbate psychotic symptoms in patients with schizophrenia. The objective of this study was to describe psychiatric outcomes in patients who receive prehospital ketamine for severe agitation.This is a retrospective cohort (...) study, conducted at two tertiary academic medical centers, utilizing chart review of patients requiring prehospital sedation for severe agitation from January 1, 2014, to June 30, 2016. Patients received either intramuscular (IM) versus intravenous (IV) ketamine or IM versus IV benzodiazepine. The primary outcome was psychiatric inpatient admission with secondary outcomes including ED psychiatric evaluation and nonpsychiatric inpatient admission. Generalized estimating equations and Fisher's exact

2019 Academic Emergency Medicine

168. Plasticity in the dynamic pain connectome associated with ketamine-induced neuropathic pain relief. (Abstract)

Plasticity in the dynamic pain connectome associated with ketamine-induced neuropathic pain relief. Therapeutic interventions for neuropathic pain (NP), such as the NMDA-antagonist ketamine, can vary widely in effectiveness; Here, we conducted a longitudinal functional MRI study to test the hypothesis that the pain relieving effect of ketamine is due to reversal of abnormalities in regional low frequency brain oscillations (LFOs) and abnormal cross-network functional connectivity (FC (...) ) of the dynamic pain connectome. We found that: 1) ketamine decreased regional LFOs in the posterior cingulate cortex (PCC) of the default mode network (DMN), 2) a machine learning algorithm demonstrated that treatment-induced brain changes could be used to make generalizable inferences about pain relief, 3) treatment responders exhibited a significant decrease in cross-network static FC between the PCC and regions of the sensorimotor (SM) and salience networks following treatment, 4) the degree of reduced

2019 Pain

169. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy. Full Text available with Trip Pro

Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy. Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy.This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years (...) ) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative.Kaplan-Meier survival analysis

2019 Saudi journal of anaesthesia Controlled trial quality: uncertain

170. Oral Clonidine Premedication Attenuates Hemodynamic Responses of Ketamine during Total Intravenous Anesthesia. Full Text available with Trip Pro

Oral Clonidine Premedication Attenuates Hemodynamic Responses of Ketamine during Total Intravenous Anesthesia. The most commonly used drug for total intravenous anesthesia (TIVA) is ketamine which results in cardiovascular stimulation.The primary aim of this study was to assess the effect of oral clonidine premedication on attenuating the hemodynamic responses following ketamine administration.This was a prospective, observational, comparative study conducted in a tertiary care institution.A (...) total of 40 female patients aged 18-55 years who were posted for elective short gynecological procedures under TIVA were recruited for this study. Group A patients were given oral clonidine 150 μg 60 min before proposed surgical procedure, whereas Group B patients received a placebo tablet. Before induction, all patients received glycopyrrolate 0.2 mg, midazolam 2 mg, and fentanyl 2 μg/kg intravenously. Anesthesia was induced with ketamine 1.5 mg/kg body weight intravenously over 2-3 min

2019 Anesthesia, essays and researches Controlled trial quality: uncertain

171. Effects of injectable dexmedetomidine-ketamine-midazolam and isoflurane inhalation anesthetic protocols on ocular variables in captive black-tailed prairie dogs ( (Abstract)

Effects of injectable dexmedetomidine-ketamine-midazolam and isoflurane inhalation anesthetic protocols on ocular variables in captive black-tailed prairie dogs ( To evaluate the effects of injectable dexmedetomidine-ketamine-midazolam (DKM) and isoflurane inhalation (ISO) anesthetic protocols on selected ocular variables in captive black-tailed prairie dogs (Cynomys ludovicianus; BTPDs).9 zoo-kept BTPDs.The BTPDs received dexmedetomidine hydrochloride (0.25 mg/kg, IM), ketamine hydrochloride

2019 American journal of veterinary research Controlled trial quality: uncertain

172. Effects of atipamezole dosage and timing of administration on recovery time and quality in cats following injectable anaesthesia incorporating ketamine. (Abstract)

Effects of atipamezole dosage and timing of administration on recovery time and quality in cats following injectable anaesthesia incorporating ketamine. The aim of this study was to establish the optimum dosage and timing of administration of atipamezole in cats undergoing general anaesthesia incorporating ketamine to provide the shortest recovery possible without unacceptably compromising recovery quality.In total, 128 healthy male cats (age range 2-108 months, weight range 0.56-5.22 kg (...) ) admitted for castration were randomly allocated to groups of 32. Anaesthesia was induced with 60 mg/m2 ketamine, 180 µg/m2 buprenorphine, 3 mg/m2 midazolam and 600 µg/m2 medetomidine intramuscularly (IM). Cats received 600 µg/m2 (groups 1ATI20 and 1ATI40) or 1.5 mg/m2 (groups 2.5ATI20 and 2.5ATI40) atipamezole IM either 20 (groups 1ATI20 and 2.5ATI20) or 40 mins (groups 1ATI40 and 2.5ATI40) after the 'quad'. Preparation time, surgical time, auricular temperature, times to sternal recumbency and first

2019 Journal of feline medicine and surgery Controlled trial quality: uncertain

173. Attenuation of antidepressant and antisuicidal effects of ketamine by opioid receptor antagonism. (Abstract)

Attenuation of antidepressant and antisuicidal effects of ketamine by opioid receptor antagonism. We recently reported that naltrexone blocks antidepressant effects of ketamine in humans, indicating that antidepressant effects of ketamine require opioid receptor activation. However, it is unknown if opioid receptors are also involved in ketamine's antisuicidality effects. Here, in a secondary analysis of our recent clinical trial, we test whether naltrexone attenuates antisuicidality effects (...) of ketamine. Participants were pretreated with naltrexone or placebo prior to intravenous ketamine in a double-blinded crossover design. Suicidality was measured with the Hamilton Depression Rating Scale item 3, Montgomery-Åsberg Depression Rating Scale item 10, and Columbia Suicide Severity Rating Scale. In the 12 participants who completed naltrexone and placebo conditions, naltrexone attenuated the antisuicidality effects of ketamine on all three suicidality scales/subscales (linear mixed model, fixed

2019 Molecular psychiatry Controlled trial quality: uncertain

174. Safety of Intranasal Ketamine for Reducing Uncontrolled Cancer-Related Pain: Protocol of a Phase I/II Clinical Trial. Full Text available with Trip Pro

Safety of Intranasal Ketamine for Reducing Uncontrolled Cancer-Related Pain: Protocol of a Phase I/II Clinical Trial. Approximately 12 million Americans are affected with cancer. Of these, 53% experience pain at all stages of cancer. Pain may remain uncontrolled despite high-dose opioid therapy, and opioids have many well-documented harmful side effects. Intranasal ketamine has been shown to be effective in controlling breakthrough noncancer pain in a double-blind randomized control trial (...) (DBRCT) by Carr et al in 2003 as well as to help with depression in a DBRCT by Lapidus et al in 2014. We seek to obtain preliminary data on the safety, feasibility, and utility of this novel technique for the treatment of uncontrolled cancer pain.This study aimed to obtain preliminary data via a clinical trial addressing the safety, feasibility, pharmacokinetics, and pharmacodynamics of intranasal ketamine. These initial findings will be applied to a subsequent trial to determine the effectiveness

2019 JMIR Research Protocols Controlled trial quality: uncertain

175. Procedural Sedation Using a Propofol-Ketamine Combination (Ketofol) vs. Propofol Alone in the Loop Electrosurgical Excision Procedure (LEEP): A Randomized Controlled Trial. Full Text available with Trip Pro

Procedural Sedation Using a Propofol-Ketamine Combination (Ketofol) vs. Propofol Alone in the Loop Electrosurgical Excision Procedure (LEEP): A Randomized Controlled Trial. Although the loop electrosurgical excision procedure (LEEP) is a brief procedure, it can cause severe pain and discomfort to patients in the absence of adequate sedation. An admixture of ketamine with propofol (ketofol), may reduce patient movement due to insufficient sedation while providing hemodynamic and respiratory (...) stability. This study evaluated the ability of two ratios of a propofol-ketamine combination, compared with propofol alone, to reduce patient movement during procedural sedation for LEEPs.One hundred and twenty women scheduled for a LEEP were randomly assigned to three groups. Anesthesia was induced with 1 mg/kg propofol (group P), 1 mg/kg propofol and 0.33 mg/kg ketamine (group K1), or 1 mg/kg propofol and 0.66 mg/kg ketamine (group K2). The primary outcome was the incidence of adduction motion

2019 Journal of clinical medicine Controlled trial quality: uncertain

176. Does Sub-Anesthetic Ketamine Provide Postoperative Analgesia for Third Molar Surgery? (Abstract)

Does Sub-Anesthetic Ketamine Provide Postoperative Analgesia for Third Molar Surgery? Despite ketamine's effectiveness as an anesthetic and its known analgesic properties, the role of ketamine in postoperative pain after third molar surgery remains unclear. Therefore, this study aimed to investigate whether patients undergoing third molar surgery who received a sub-anesthetic preoperative dose of intravenous ketamine would experience less postoperative pain.We implemented a randomized, double (...) -blinded, placebo-controlled trial. The study sample consisted of participants undergoing third molar surgery with procedural sedation anesthesia. Participants were randomized to receive a preoperative intravenous dose of ketamine or placebo, as predictor variables. The primary outcome variable was postoperative pain intensity determined by a 10-point visual analog scale at 6-hour intervals over a period of 48 hours. The secondary outcome variable was the quantity of postoperative non-opioid and opioid

2019 Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons Controlled trial quality: predicted high

177. Comparison of intranasal midazolam, intranasal ketamine, and oral chloral hydrate for conscious sedation during paediatric echocardiography: results of a prospective randomised study. (Abstract)

Comparison of intranasal midazolam, intranasal ketamine, and oral chloral hydrate for conscious sedation during paediatric echocardiography: results of a prospective randomised study. There are several agents used for conscious sedation by various routes in children. The aim of this prospective randomised study is to compare the effectiveness of three commonly used sedatives: intranasal ketamine, intranasal midazolam, and oral chloral hydrate for children undergoing transthoracic (...) echocardiography.Children who were referred to paediatric cardiology due to a heart murmur for transthoracic echocardiography were prospectively randomised into three groups. Seventy-three children received intranasal midazolam (0.2 mg/kg), 72 children received intranasal ketamine (4 mg/kg), and 72 children received oral chloral hydrate (50 mg/kg) for conscious sedation. The effects of three agents were evaluated in terms of intensity, onset, and duration of sedation. Obtaining high-quality transthoracic

2019 Cardiology in the young Controlled trial quality: uncertain

178. Prophylactic use of ketamine reduces postpartum depression in Chinese women undergoing cesarean section (Abstract)

Prophylactic use of ketamine reduces postpartum depression in Chinese women undergoing cesarean section This study aimed to explore the effect of prophylactic ketamine administration on postpartum depression in Chinese woman undergoing cesarean section. This randomized controlled study included 654 Chinese women undergoing cesarean section. At 10 min after child birth, patients in the ketamine group were given 0.5 mg/kg ketamine, whereas patients in the control group received standard (...) postpartum care. At the end of operation, all patients were armed with a patient-controlled intravenous analgesia device. The primary outcome was the prevalence of postpartum depression (PPD), as assessed by the Edinburgh Postnatal Depression Scale (EPDS), and the secondary outcomes included the safety assessment and the Numerical Rating Scale (NRS) of postoperative pain. The prevalence of postpartum blues and postpartum depression were significantly lower in the ketamine group than in the control group

2019 Psychiatry research Controlled trial quality: uncertain

179. Dextromethorphan and memantine after ketamine analgesia: a randomized control trial. Full Text available with Trip Pro

Dextromethorphan and memantine after ketamine analgesia: a randomized control trial. Intravenous ketamine is often prescribed in severe neuropathic pain. Oral N-methyl-D-aspartate receptor (NMDAR) antagonists might prolong pain relief, reducing the frequency of ketamine infusions and hospital admissions. This clinical trial aimed at assessing whether oral dextromethorphan or memantine might prolong pain relief after intravenous ketamine.A multicenter randomized controlled clinical trial (...) included 60 patients after ketamine infusion for refractory neuropathic pain. Dextromethorphan (90 mg/day), memantine (20 mg/day) or placebo was given for 12 weeks (n=20 each) after ketamine infusion. The primary endpoint was pain intensity at one month. Secondary endpoints included pain, sleep, anxiety, depression, cognitive function and quality of life evaluations up to 12 weeks.At 1 month, dextromethorphan maintained ketamine pain relief (Numeric Pain Scale: 4.01±1.87 to 4.05±2.61, p=0.53

2019 Drug design, development and therapy Controlled trial quality: uncertain

180. Association between dynamic resting-state functional connectivity and ketamine plasma levels in visual processing networks. Full Text available with Trip Pro

Association between dynamic resting-state functional connectivity and ketamine plasma levels in visual processing networks. Numerous studies demonstrate ketamine's influence on resting-state functional connectivity (rsFC). Seed-based and static rsFC estimation methods may oversimplify FC. These limitations can be addressed with whole-brain, dynamic rsFC estimation methods. We assessed data from 27 healthy subjects who underwent two 3 T resting-state fMRI scans, once under subanesthetic (...) suggesting that esketamine's influence on dynamic rsFC is highly stable in visual processing networks. Our findings may be reflective of ketamine's role as a model for psychosis, a disorder associated with alterations to visual processing and impaired inter-hemispheric connectivity. Ketamine is a highly effective antidepressant and studies have shown changes to sensory processing in depression. Dynamic rsFC in sensory processing networks might be a promising target for future investigations of ketamine's

2019 Scientific reports Controlled trial quality: uncertain

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