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Latest & greatest articles for ketamine
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Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events Journal Club Eastern Virginia Medical School Therapy Article Presenter: Allison Wood Date: 8/31/20 Citation: Conway, J., et al, Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence of Adverse Hemodynamic Events. Critical Care Medicine, 47, p.498. I. WHAT IS BEING STUDIED? 1. Study Objective To study “whether (...) the administration of ketamine for tracheal intubation in critically ill children with or without shock was associated with fewer adverse hemodynamic events compared with other induction agents.” “We also investigated if there was a dose dependence for any association between ketamine use and adverse hemodynamic events.” 2. Study Design Retrospective analysis of prospectively collected observational data from the NEAR4KIDS and PALISI databases that included 40 PICU’s in US & Canada 3. Inclusion Criteria All
Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review. For years, the use of ketamine as an anesthetic to patients suffering from acute brain injury has been debated because of its possible deleterious effects on the cerebral circulation and thus on the cerebral perfusion. Early studies suggested that ketamine could increase the intracranial pressure thus lowering the cerebral perfusion and hence reduce the oxygen supply to the injured brain. However, more recent (...) studies are less conclusive and might even indicate that patients with acute brain injury could benefit from ketamine sedation. This systematic review summarizes the evidence regarding the use of ketamine in patients suffering from traumatic brain injury. Databases were searched for studies using ketamine in acute brain injury. Outcomes of interest were mortality, intracranial pressure, cerebral perfusion pressure, blood pressure, heart rate, spreading depolarizations, and neurological function
Ketamine Treatment in Depression: A Systematic Review of Clinical Characteristics Predicting Symptom Improvement. Ketamine has been shown to be efficacious for the treatment of depression, specifically among individuals who do not responded to first-line treatments. There is still, however, a lack of clarity surrounding the clinical features and response periods across samples that respond to ketamine. This paper systematically reviews published randomized, controlled trials that investigate (...) ketamine as an antidepressant intervention in both unipolar and bipolar depression to determine the specific clinical features of the samples across different efficacy periods. Moreover, similarities and differences in clinical characteristics associated with acute versus longer-term drug response are discussed. Similarities across all samples suggest that the population that responds to ketamine's antidepressant effect have experienced chronic, long-term depression, approaching ketamine treatment
Efficacy of single and repeated administration of ketamine in unipolar and bipolar depression: a meta-analysis of randomized clinical trials. Due to unmet clinical needs for efficient drugs with a rapid onset of antidepressant effects, we aimed to evaluate the efficacy of single-dose ketamine in different subgroups of patients with major depression and establish whether repeated ketamine administration could be a viable strategy to maintain treatment gains.Electronic databases (Medline via (...) PubMed, Embase, Cochrane Library, Trip Database) were systematically searched until February 22, 2019, for published peer-reviewed randomized controlled trials (RCTs) concerning a single and repeated administration of ketamine in patients with major depression. All relevant RCTs were selected and critically appraised, and a meta-analysis of eligible studies was performed.A total of 20 studies were included in the meta-analysis. The largest effect of ketamine vs. controls in reducing depressive
Ketamine as a Prehospital Analgesic: A Systematic Review. Analgesia in the prehospital setting is an extremely important, yet controversial topic. Ketamine, a N-methyl D-aspartate (NMDA) receptor antagonist, has been commonly used in the prehospital setting, including recommendations by the US Department of Defense and by the Royal Australian College of Pain Medicine, despite the paucity of high-level evidence.Accordingly, a review of the literature was conducted using several electronic (...) medical literature databases from the earliest available records to the time at which the search was conducted (October 2018).The search strategy yielded a total of 707 unique papers, of which 43 were short-listed for full review, and ultimately, ten papers were identified as meeting all the relevant inclusion criteria. The included studies varied significantly in the prehospital context and in the means of administering ketamine. There was only low-grade evidence that ketamine offered a safe
Topical application of ketamine to prevent postoperative sore throat in adults: A systematic review and meta-analysis. Postoperative sore throat is a leading undesirable postoperative outcome. Ketamine is an N-methyl-d-aspartate receptor antagonist and its topical application is used for chronic pain and oral/throat indications. We conducted a systematic review to assess the efficacy of preoperative, topical ketamine application for preventing postoperative sore throat.We searched MEDLINE (...) , EMBASE, and CENTRAL through September 23, 2019 for randomized controlled trials in which at least one intervention was topical ketamine to prevent postoperative sore throat in adults undergoing endotracheal intubation. The primary outcome was the incidence of sore throat at 24 hours postoperatively. The comparators were non-analgesic controls (placebo, no treatment, or usual care) or active agents. We pooled the data using a random-effects model.We included 41 randomized controlled trials involving
The Efficacy of Ketamine Administration in Prehospital Pain Management of Trauma Patients; a Systematic Review and Meta-Analysis. Although previous articles and reviews suggest that ketamine might effectively manage pain in trauma patients, these articles have serious limitations. Accordingly, the current meta-analysis aims to investigate the efficacy of ketamine administration in prehospital pain management of trauma patients.In the present meta-analysis, controlled human studies were included (...) . An extensive search was conducted in electronic databases including Medline (via PubMed), Embase, Central, Scopus, Web of Science, and ProQuest, gathering data to the end of 2018. The efficacy and side effects of ketamine administration in pre-hospital pain management were compared with those of opioid analgesics based on standard mean difference (SMD) and odds ratio (OR) calculations with 95% confidence interval (95% CI).Data from seven articles were included in the present meta-analysis. Ketamine
Ketamine Procedural Sedation for Children in EDs The Royal College of Emergency Medicine Best Practice Guideline KETAMINE PROCEDURAL SEDATION FOR CHILDREN IN THE EMERGENCY DEPARTMENT Revised: February 2020 Ketamine Procedural Sedation for Children in The Emergency Department (Feb 2020) 15 Summary of recommendations 1. Ketamine sedation may be appropriate for a procedure that is painful, or frightening after all other options have been considered. 2. Ketamine should not be used for sedation (...) in the Emergency Department for children under the age of 1 year. Ketamine should be only be used by clinicians with significant relevant experience in the use of ketamine when performing procedural sedation in children aged between 2-5 years. 3. Ketamine sedation should take place in an area with full resuscitation facilities immediately available. 4. Safe sedation requires adequate senior medical and nursing cover in the Emergency Department when any sedation takes place. 5. Ketamine sedation requires
Local Ketamine Improves Postoperative Analgesia After Third Molar Surgery. Evidence exists to support the peripheral analgesic effect of local administration of ketamine (LAK) after third molar surgery. The aim of the present systematic review and meta-analysis was to determine the efficacy of LAK in the control of pain, swelling, and trismus after third molar surgery.The study design was a systematic review with a meta-analysis of the effect of LAK after third molar surgery. A search
Impact of Ketamine on Pain Management in Cesarean Section: A Systematic Review and Meta-Analysis. The pain control effect of ketamine versus control in women during cesarean operation is not well determined.The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus control in cesarean section anesthesia for reducing the postoperative pain and analgesia.We used meta-analysis to address this concern.Meta-analysis-based study.The databases PubMed, Embase, and the Cochrane (...) Library were systematically searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus control in controlling pain after cesarean section from inception to August 2018. Based on the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software.A total of 20 RCTs with 1,737 patients who underwent cesarean section were included. Meta-analysis showed that the pain score in the ketamine group was less than that of the control group (mean difference [MD
What urologists need to know about ketamine-induced uropathy: A systematic review. Ketamine is a general anesthetic. Dissociative effects and low cost led ketamine becoming an illegal recreational drug in young adults. Ketamine-induced uropathy (KIU) is one of the complications observed in abusers. This study aimed to provide a systematic literature review on KIU clinical presentation, pathophysiology, and treatments.We performed the literature search in PubMed, Web of Science, Scopus (...) , and Embase using the terms ketamine and bladder. English papers on human and animal studies were accepted.A total of 75 papers were selected. Regular ketamine users complain about severe storage symptoms and pelvic pain. Hydronephrosis may develop in long-term abusers and is correlated to the contracted bladder, ureteral stenosis, or vesicoureteral reflux due to ureteral involvement and/or bladder fibrosis. Cystoscopy shows ulcerative cystitis. Ketamine in urine might exert direct toxicity
Ketamine sedation in mechanically ventilated patients: A systematic review and meta-analysis. Ketamine use as a sedative agent in mechanically ventilated patients is increasing. This systematic review and meta-analysis collates existing literature and quantifies the impact of ketamine in mechanically ventilated patients.EMBASE, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, conference proceedings, and reference lists were searched. Randomized (...) and nonrandomized studies were included, and two reviewers independently screened abstracts of identified studies for eligibility.Fifteen studies (n = 892 patients) were included. Random effects meta-analytic models revealed that ketamine was associated with a reduction in propofol infusion rate (mean difference in dose, -699 μg/min; 95% CI -1169 to -230, p = .003), but had no impact on fentanyl or midazolam. Ketamine was not associated with mortality, on-target sedation, vasopressor dependence, or hospital
Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis. Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis (...) was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering.We searched the following databases: Medline, Embase, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the difference of the incidence rate of postanesthetic shivering between ketamine group and placebo group. The secondary outcomes were the sedation score and incidence of the side effects caused by ketamine
Using Ketamine and Propofol for Procedural Sedation of Adults in the Emergency Department: A Systematic Review and Meta-Analysis. Purpose: Ketamine-propofol combination (ketofol) is being used to provide a safe and effective procedural sedation (PS) in emergency department (ED) and may theoretically have beneficial effects since using lower doses of each drug may result in a reduction of the adverse events of both agents while maintaining optimal conditions for performing procedures (...) group. Conclusion: Ketamine/propofol mixture (ketofol) has less respiratory adverse effects than propofol alone in ED procedural sedation.
Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of ketamine for suicidality.CENTRAL, EMBASE, Medline, and PsycINFO were searched until 12 December 2018. Randomised (...) controlled trials of ketamine or esketamine reporting data on suicidal ideation, self-harm, attempted or completed suicide in adults diagnosed with any psychiatric disorder were included. Two reviewers independently extracted data, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Standardised mean difference was used for continuous outcomes.Twenty-five reports from 15 independent trials, with a total of 572 participants diagnosed