Assuntos
Anestesia por Condução , Ketamina , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Ketamina/efeitos adversos , Ketamina/administração & dosagem , Anestesia por Condução/efeitos adversos , Anestesia por Condução/métodos , Anestésicos Dissociativos/efeitos adversos , Anestésicos Dissociativos/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologiaRESUMO
OBJECTIVES: To provide guidance in the form of consensus statement in the management of ketamine uropathy. METHODS: A literature review of ketamine uropathy was performed. The consensus method was of a modified nominal group technique and has been use in the previous British Association of Urological Surgeons (BAUS) consensus documents and was led by the Female, Neurological and Urodynamic Urology Section of the BAUS. RESULTS: A number of consensus statements detailing the assessment and management of urological complications relate to the recreational use of ketamine (ketamine uropathy) in both elective and emergency urology settings. CONCLUSION: Comprehensive management pathway for ketamine-related urinary tract dysfunction and uropathy has been detailed.
Assuntos
Ketamina , Feminino , Humanos , Masculino , Anestésicos Dissociativos/efeitos adversos , Consenso , Ketamina/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Reino Unido , Doenças Urológicas/induzido quimicamente , Doenças Urológicas/terapia , Urologia/normasRESUMO
BACKGROUND: Dexmedetomidine is an alternative agent for procedural sedation in the emergency department thanks to its ability to maintain hemodynamic and respiratory stability. Dexmedetomidine must, however, be combined with a powerful analgesic. OBJECTIVE: Our aim was to evaluate the quality and safety of procedural sedation using the combination of dexmedetomidine and ketamine for patients undergoing painful procedures in the emergency department. METHODS: This prospective interventional single-center study was conducted in an academic emergency department of an urban hospital in Brussels, Belgium. Patients received a bolus injection of 1 µg/kg dexmedetomidine over 10 min and then a continuous infusion of 0.6 µg/kg/h followed by a bolus of 1 mg/kg ketamine. The painful procedure was carried out 1 min later. The level of pain was evaluated with a numerical rating scale from 0 (no pain) to 10 (maximal pain). The level of patient comfort for the procedure was measured using a comfort scale. RESULTS: Thirty patients were included. Overall, 90% of patients felt little or no pain (n = 29 of 30) or discomfort (n = 28 of 30) during the procedure. One patient experienced apnea with desaturation, which was resolved by a jaw-thrust maneuver. Although 23% of patients had significant arterial hypertension, none required drug treatment. CONCLUSIONS: The combination of dexmedetomidine and ketamine provides conscious sedation, bringing comfort and pain relief to patients in optimal conditions for respiratory and hemodynamic safety. However, sedation and recovery times are longer than with conventional drug combinations. The dexmedetomidine-ketamine combination should therefore be recommended for nonurgent procedures and fragile patients.
Assuntos
Dexmedetomidina , Ketamina , Anestésicos Dissociativos/efeitos adversos , Sedação Consciente/métodos , Dexmedetomidina/efeitos adversos , Combinação de Medicamentos , Serviço Hospitalar de Emergência , Humanos , Hipnóticos e Sedativos/farmacologia , Hipnóticos e Sedativos/uso terapêutico , Ketamina/efeitos adversos , Dor/tratamento farmacológico , Dor/etiologia , Estudos ProspectivosRESUMO
Although women and men are equally likely to receive ketamine following traumatic injury, little is known regarding sex-related differences in the impact of ketamine on traumatic memory. We previously reported that subanesthetic doses of an intravenous (IV) ketamine infusion following fear conditioning impaired fear extinction and altered regional brain glucose metabolism (BGluM) in male rats. Here, we investigated the effects of IV ketamine infusion on fear memory, stress hormone levels, and BGluM in female rats. Adult female Sprague-Dawley rats received a single IV ketamine infusion (0, 2, 10, or 20 mg/kg, over a 2-h period) following auditory fear conditioning (three pairings of tone and footshock). Levels of plasma stress hormones, corticosterone (CORT) and progesterone, were measured after the ketamine infusion. Two days after ketamine infusion, fear memory retrieval, extinction, and renewal were tested over a three-day period. The effects of IV ketamine infusion on BGluM were determined using 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG-PET) and computed tomography (CT). The 2 and 10 mg/kg ketamine infusions reduced locomotor activity, while 20 mg/kg infusion produced reduction (first hour) followed by stimulation (second hour) of activity. The 10 and 20 mg/kg ketamine infusions significantly elevated plasma CORT and progesterone levels. All three doses enhanced fear memory retrieval, impaired fear extinction, and enhanced cued fear renewal in female rats. Ketamine infusion produced dose-dependent effects on BGluM in fear- and stress-sensitive brain regions of female rats. The current findings indicate that subanesthetic doses of IV ketamine produce robust effects on the hypothalamic-pituitary-adrenal (HPA) axis and brain energy utilization that may contribute to enhanced fear memory observed in female rats.
Assuntos
Anestésicos Dissociativos/administração & dosagem , Encéfalo/diagnóstico por imagem , Condicionamento Psicológico/efeitos dos fármacos , Medo/efeitos dos fármacos , Glucose/metabolismo , Ketamina/administração & dosagem , Anestésicos Dissociativos/efeitos adversos , Animais , Encéfalo/efeitos dos fármacos , Encéfalo/metabolismo , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Feminino , Fluordesoxiglucose F18/administração & dosagem , Fluordesoxiglucose F18/metabolismo , Infusões Intravenosas , Ketamina/efeitos adversos , Tomografia por Emissão de Pósitrons , Ratos , Ratos Sprague-Dawley , Tomografia Computadorizada por Raios XRESUMO
The black market for new psychoactive substances has been constantly evolving and the substances that appear on this market cause a considerable number of issues, in extreme cases leading to human deaths. While monitoring the drug black market, we detected a sample of a dissociative anesthetic methoxphenidine, the salt of which contained an unusual anion in the form of bromo- and chloro-zincate complex. Concerning the unknown and potentially hazardous properties of this sample, we performed an in vitro cytotoxicity screening in cell lines of various origins (e.g., kidney, liver, bladder) which was compared with the toxicity results of the methoxphenidine standard prepared for this purpose. The street methoxphenidine sample exhibited markedly higher toxicity than the standard, which was probably caused by the anion impurity. Since it is not usual to analyze anions in salts of novel psychoactive substances, but such samples may be commonly available at the drug black market, we have developed a method for their identification with X-ray powder diffraction (XRPD), which also enabled us to distinguish between different polymorphs/solvates of methoxphenidine that were crystallized in the laboratory. XRPD offers additional data about samples, which may not be discovered by routine techniques, and in some cases, they may help to find out essential information.
Assuntos
Anestésicos Dissociativos/efeitos adversos , Drogas Ilícitas/efeitos adversos , Piperidinas/efeitos adversos , Células Cultivadas , Humanos , Psicotrópicos/efeitos adversos , Difração de Raios X/métodosRESUMO
Neurobehavioral deficits emerge in nearly 50% of patients following a mild traumatic brain injury (TBI) and may persist for months. Ketamine is used frequently as an anesthetic/analgesic and for management of persistent psychiatric complications. Although ketamine may produce beneficial effects in patients with a history of TBI, differential sensitivity to its impairing effects could make the therapeutic use of ketamine in TBI patients unsafe. This series of studies examined male C57BL/6â¯J mice exposed to a mild single blast overpressure (mbTBI) for indications of altered sensitivity to ketamine at varying times after injury. Dystaxia (altered gait), diminished sensorimotor gating (reduced prepulse inhibition) and impaired working memory (step-down inhibitory avoidance) were examined in mbTBI and sham animals 15â¯min following intraperitoneal injections of saline or R,S-ketamine hydrochloride, from day 7-16 post injury and again from day 35-43 post injury. Behavioral performance in the forced swim test and sucrose preference test were evaluated on day 28 and day 74 post injury respectively, 24â¯h following drug administration. Dynamic gait stability was compromised in mbTBI mice on day 7 and 35 post injury and further exacerbated following ketamine administration. On day 14 and 42 post injury, prepulse inhibition was robustly decreased by mbTBI, which ketamine further reduced. Ketamine-associated memory impairment was apparent selectively in mbTBI animals 1â¯h, 24â¯h and day 28 post shock (tested on day 15/16/43 post injury). Ketamine selectively reduced immobility scores in the FST in mbTBI animals (day 28) and reversed mbTBI induced decreases in sucrose consumption (Day 74). These results demonstrate increased sensitivity to ketamine in mice when tested for extended periods after TBI. The results suggest that ketamine may be effective for treating neuropsychiatric complications that emerge after TBI but urge caution when used in clinical practice for enhanced sensitivity to its side effects in this patient population.
Assuntos
Anestésicos Dissociativos/farmacologia , Comportamento Animal/efeitos dos fármacos , Traumatismos por Explosões/psicologia , Lesões Encefálicas Traumáticas/psicologia , Ketamina/farmacologia , Anestésicos Dissociativos/efeitos adversos , Animais , Ataxia/etiologia , Ataxia/psicologia , Concussão Encefálica , Ketamina/efeitos adversos , Coxeadura Animal/induzido quimicamente , Coxeadura Animal/psicologia , Masculino , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Camundongos , Camundongos Endogâmicos C57BL , Atividade Motora/efeitos dos fármacos , Inibição Pré-Pulso , Desempenho Psicomotor/efeitos dos fármacos , Filtro Sensorial/efeitos dos fármacosAssuntos
Anestésicos Dissociativos/farmacologia , Ketamina/farmacologia , Receptores de N-Metil-D-Aspartato/antagonistas & inibidores , Anestésicos Dissociativos/administração & dosagem , Anestésicos Dissociativos/efeitos adversos , Peso Corporal , Interações Medicamentosas , Humanos , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Aplicação da LeiRESUMO
BACKGROUND: There is a paucity of literature around sedation and anesthesia in patients with severe anorexia nervosa. Chronically malnourished patients are known to have myopathy, neuropathy, and altered neurotransmitter signaling. Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist that is an established general anesthetic and short-acting dissociative analgesic agent. It generally has a reassuring adverse event profile and rarely has been reported to result in apnea. We aim to raise awareness of this untoward adverse event in patients with severe anorexia nervosa among sedation providers and those referring patients for hospitalization or sedation. CASE PRESENTATION: We describe an episode of apnea, a rare adverse event of ketamine, which was given for procedural sedation to a severely malnourished 13-year-old female with anorexia nervosa, generalized anxiety disorder, and high-functioning autism spectrum disorder. She had no history of apnea nor of ketamine sedation. She was given a standard dose of ketamine and had no other central nervous system depressants within 24 h. Within 1 min after slow medication administration, she had a 9-min period of apnea without laryngospasm. She was supported with bag-valve-mask ventilation throughout this period and did not require intubation. She returned to baseline shortly after procedural sedation. CONCLUSIONS: This case describes apnea after ketamine sedation in a patient with severe anorexia nervosa. It supports the importance of a thorough pre-procedure review of a patient's underlying medical problems and the consideration of how sedatives may interact with these conditions. We aim to alert those who care for this complex population of the possible altered neurotransmitters, myopathy, and adverse response to sedation, anesthetics, and analgesics.
Assuntos
Anestesia , Anorexia Nervosa , Transtorno do Espectro Autista , Ketamina , Adolescente , Anestésicos Dissociativos/efeitos adversos , Anorexia Nervosa/complicações , Anorexia Nervosa/tratamento farmacológico , Apneia/induzido quimicamente , Apneia/tratamento farmacológico , Transtorno do Espectro Autista/induzido quimicamente , Transtorno do Espectro Autista/tratamento farmacológico , Serviço Hospitalar de Emergência , Feminino , Humanos , Ketamina/efeitos adversosRESUMO
The history of ketamine begins in 1962, when Calvin Stevens of the pharmaceutical laboratory Parke-Davis synthesizes it from phencyclidine, a molecule with psychodysleptic, hallucinogenic and dissociative properties. Following the first administration of ketamine to humans in 1964 in Jackson prison (Michigan, USA), its dissociative effects associated with short anaesthesia were reported, and a patent for its human use was filed in 1966. In the 1990s, the discovery of opioid-induced hyperalgesia sparked interest in ketamine as an analgesic. In recent years, the human use of ketamine, and in particular its esketamine enantiomer, has shifted towards the treatment of depression. The first cases of ketamine abuse were reported in 1992 in France, leading to special surveillance by the health authorities, and its inclusion in the list of narcotic drugs in 1997. Today, ketamine has become an attractive substance for recreational use, gradually emerging from alternative techno circles to spread to more commercial party scenes. These elements represent a public health concern, associated with the risk of developing new chemically synthesized analogues, the harmful effects of which are still little known.
Assuntos
Anestésicos Dissociativos/história , Ketamina , Anestésicos Dissociativos/efeitos adversos , História do Século XX , História do Século XXI , Humanos , Ketamina/efeitos adversos , Ketamina/história , Estereoisomerismo , Transtornos Relacionados ao Uso de SubstânciasRESUMO
BACKGROUNDS: Ketamine is a dissociative anesthetic that is currently considered for several new indications. AIM: To deduce the safety of long-term ketamine treatment using the harm of heavy recreational (non-medical) ketamine use as a proxy for maximal possible harm of ketamine treatment. METHODS: Systematic literature review according to PRISMA guidelines to identify controlled studies on ketamine-related harm in heavy recreational ketamine users. Results were compared with serious adverse events (SAEs) in patients treated with ketamine according to three systematic reviews considering dosing regimen and cumulative dose. RESULTS: The systematic search yielded 25 studies. Heavy recreational ketamine use can escalate to ketamine dependency and was often dose-dependently associated with other SAEs, including cognitive and mental disorders, and gastrointestinal and urinary tract symptoms, which disappeared upon marked reduction of ketamine use. Heavy ketamine users have a much higher cumulative exposure to ketamine than ketamine treated patients (>90 times), which may explain why SAEs in the clinical context are mostly mild and reversible and why ketamine dependence was not reported in these patients. CONCLUSION: Treatment of patients with ketamine is not associated with ketamine dependency or SAEs. However, caution is needed since data on long-term clinical ketamine use with a long-term follow-up is lacking.
Assuntos
Ketamina/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/complicações , Anestésicos Dissociativos/administração & dosagem , Anestésicos Dissociativos/efeitos adversos , Relação Dose-Resposta a Droga , Humanos , Ketamina/efeitos adversos , Fatores de TempoRESUMO
BACKGROUND: Depressive symptoms occur in over 40% of neurosurgical patients during the perioperative period. However, no measure has been suggested to have a rapid effect on depressive surgical patients during increasingly shorter stays in the hospital. This study aimed to determine whether ketamine could improve depressive symptoms rapidly and safely during the hospital stay. METHODS: This was a randomized, placebo-controlled, and double-blinded trial. Patients with moderate-to-severe depressive symptoms undergoing elective supratentorial brain tumor resection were randomized to intravenously receive either (1) 0.5 mg·kg-1 ketamine for 40 minutes or (2) an identical volume of normal saline. The primary outcome was treatment response on postoperative day 3, defined as a ≥50% reduction from the baseline depressive score. The secondary outcomes included the rate of remission and safety outcomes. The Montgomery-Åsberg Depression Rating Scale was applied by trained psychiatrists to evaluate depressive symptoms. RESULTS: A total of 84 neurosurgical patients were enrolled in the trial. The response rate was increased by the administration of ketamine (41.5% [17/41] vs 16.3% [7/43]; relative risk [RR]: 2.51, 95% confidence interval [CI], 1.18-5.50) relative to the administration of placebo at 3 days. Furthermore, the remission rate at discharge (29.3% [12/41] vs 7.0% [3/43]; RR: 4.20, 95% CI, 1.28-13.80) was also improved by ketamine. No psychotic symptoms or adverse events were reported to be substantially higher in the ketamine group. CONCLUSIONS: The trial indicates that the intraoperative administration of ketamine could alleviate moderate-to-severe depressive symptoms in neurosurgical patients without worsening safety.
Assuntos
Anestésicos Dissociativos/uso terapêutico , Antidepressivos/uso terapêutico , Neoplasias Encefálicas/psicologia , Neoplasias Encefálicas/cirurgia , Depressão/tratamento farmacológico , Ketamina/uso terapêutico , Adolescente , Adulto , Anestésicos Dissociativos/efeitos adversos , Antidepressivos/efeitos adversos , Depressão/complicações , Método Duplo-Cego , Feminino , Humanos , Ketamina/efeitos adversos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: Ketamine is commonly used to treat profound agitation in the prehospital setting. Early in ketamine's prehospital use, intubation after arrival in the emergency department (ED) was frequent. We sought to measure the frequency of ED intubation at a Midwest academic medical center after prehospital ketamine use for profound agitation, hypothesizing that intubation has become less frequent as prehospital ketamine has become more common and prehospital dosing has improved. METHODS: We conducted a retrospective cohort study of adult patients receiving ketamine in the prehospital setting for profound agitation and transported to a midwestern, 60,000-visit, Level 1 trauma center between January 1, 2017-March 1, 2021. We report descriptive analyses of patient-level prehospital clinical data and ED outcomes. The primary outcome was proportion of patients intubated in the ED. RESULTS: A total of 78 patients received ketamine in the prehospital setting (69% male, mean age 36 years). Of the 42 (54%) admitted patients, 15 (36% of admissions) were admissions to the intensive care unit. Overall, 12% (95% confidence interval [CI]), 4.5-18.6%)] of patients were intubated, and indications included agitation (n = 4), airway protection not otherwise specified (n = 4), and respiratory failure (n = 1). CONCLUSION: Endotracheal intubation in the ED after prehospital ketamine use for profound agitation in our study sample was found to be less than previously reported.
Assuntos
Analgésicos/administração & dosagem , Anestésicos Dissociativos/administração & dosagem , Serviços Médicos de Emergência/estatística & dados numéricos , Ketamina/administração & dosagem , Agitação Psicomotora/tratamento farmacológico , Adulto , Anestésicos Dissociativos/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Intubação Intratraqueal , Ketamina/efeitos adversos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: The present study was designed to evaluate the effect of dexmedetomidine and propofol on ketamine-induced recovery agitation in adults when used as co-administration with ketamine. METHODS: In this prospective, randomized, and double-blind clinical trial, 93 patients aged 18 years or older who were candidates for painful procedures in the emergency department (ED) were enrolled and assigned into three equal groups to receive either ketadex (dexmedetomidine 0.7 µg/kg and ketamine 1 mg/kg), ketofol (propofol 0.5 mg/kg and ketamine 0.5 mg/kg) or ketamine alone (1 mg/kg) intravenously. Incidence and severity of recovery agitation were evaluated using the Richmond Agitation-Sedation Scale and compared between groups. RESULTS: There were no significant differences in demographic characteristics, procedures, pain scores, pre-sedation agitation, and duration of procedure between the three groups. The incidence of recovery agitation was 26% in the Ketadex group, 29% in the Ketofol group, and 58% in the Ketamine group. The difference in incidence of recovery agitation between Ketadex group and Ketamine group was 32% (95% confidence interval (CI), 9 to 56]) and between Ketofol group and Ketamine group was 29% (95% CI, 6 to 53). The severe agitation was significantly higher in Ketamine group, with a difference between Ketamine and Ketadex group of 19% (95% CI, 6 to 33), and a difference between Ketamine and Ketofol group of 16% (95% CI, 1 to 31). CONCLUSIONS: In this study, a combination of ketamine-dexmedetomidine and ketamine-propofol reduced the incidence and severity of ketamine-induced recovery agitation in adults undergoing procedural sedation in the ED.
Assuntos
Anestésicos Dissociativos/efeitos adversos , Sedação Consciente/métodos , Dexmedetomidina/administração & dosagem , Serviço Hospitalar de Emergência , Hipnóticos e Sedativos/administração & dosagem , Ketamina/efeitos adversos , Propofol/administração & dosagem , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/etiologia , Adulto , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Masculino , Medição da Dor , Estudos ProspectivosRESUMO
BACKGROUND: Closed-loop control of propofol-remifentanil anesthesia using the processed electroencephalography depth-of-hypnosis index provided by the NeuroSENSE monitor (WAVCNS) has been previously described. The purpose of this placebo-controlled study was to evaluate the performance (percentage time within ±10 units of the setpoint during the maintenance of anesthesia) of a closed-loop propofol-remifentanil controller during induction and maintenance of anesthesia in the presence of a low dose of ketamine. METHODS: Following ethical approval and informed consent, American Society of Anesthesiologist (ASA) physical status I-II patients aged 19-54 years, scheduled for elective orthopedic surgery requiring general anesthesia for >60 minutes duration, were enrolled in a double-blind randomized, placebo-controlled, 2-group equivalence trial. Immediately before induction of anesthesia, participants in the ketamine group received a 0.25 mg·kg-1 bolus of intravenous ketamine over 60 seconds followed by a continuous 5 µg·kg-1·min-1 infusion for up to 45 minutes. Participants in the control group received an equivalent volume of normal saline. After the initial study drug bolus, closed-loop induction of anesthesia was initiated; propofol and remifentanil remained under closed-loop control until the anesthetic was tapered and turned off at the anesthesiologist's discretion. An equivalence range of ±8.99% was assumed for comparing controller performance. RESULTS: Sixty patients participated: 41 males, 54 ASA physical status I, with a median (interquartile range [IQR]) age of 29 [23, 38] years and weight of 82 [71, 93] kg. Complete data were available from 29 cases in the ketamine group and 27 in the control group. Percentage time within ±10 units of the WAVCNS setpoint was median [IQR] 86.6% [79.7, 90.2] in the ketamine group and 86.4% [76.5, 89.8] in the control group (median difference, 1.0%; 95% confidence interval [CI] -3.6 to 5.0). Mean propofol dose during maintenance of anesthesia for the ketamine group was higher than for the control group (median difference, 24.9 µg·kg-1·min-1; 95% CI, 6.5-43.1; P = .005). CONCLUSIONS: Because the 95% CI of the difference in controller performance lies entirely within the a priori equivalence range, we infer that this analgesic dose of ketamine did not alter controller performance. Further study is required to confirm the finding that mean propofol dosing was higher in the ketamine group, and to investigate the implication that this dose of ketamine may have affected the WAVCNS.
Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia com Circuito Fechado , Anestesia Geral , Anestésicos Dissociativos/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Monitorização Neurofisiológica Intraoperatória , Ketamina/administração & dosagem , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Adulto , Analgésicos Opioides/efeitos adversos , Anestesia com Circuito Fechado/efeitos adversos , Anestesia Geral/efeitos adversos , Anestésicos Dissociativos/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Colúmbia Britânica , Método Duplo-Cego , Eletroencefalografia , Feminino , Humanos , Ketamina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos , Complicações Pós-Operatórias/etiologia , Propofol/efeitos adversos , Remifentanil/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemAssuntos
Doenças dos Ductos Biliares , COVID-19 , Monitoramento de Medicamentos/métodos , Doença Hepática Terminal , Ketamina , Respiração Artificial/métodos , Administração Intravenosa , Anestésicos Dissociativos/administração & dosagem , Anestésicos Dissociativos/efeitos adversos , Doenças dos Ductos Biliares/sangue , Doenças dos Ductos Biliares/induzido quimicamente , Doenças dos Ductos Biliares/patologia , Doenças dos Ductos Biliares/terapia , Biópsia/métodos , COVID-19/epidemiologia , COVID-19/terapia , Relação Dose-Resposta a Droga , Duração da Terapia , Doença Hepática Terminal/induzido quimicamente , Doença Hepática Terminal/diagnóstico , Doença Hepática Terminal/mortalidade , Feminino , França/epidemiologia , Alemanha/epidemiologia , Humanos , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Testes de Função Hepática/métodos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , SARS-CoV-2RESUMO
BACKGROUND: Drugs such as propofol and ketamine are used alone or in combination to provide sedation for medical procedures in children. The purpose of this systematic review was to compare the safety and effectiveness of propofol and ketamine to other drug regimens. METHODS: We searched Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), Web of Science, and the grey literature (meta-Register of Controlled Trials, ClinicalTrials.gov, and Google Scholar) for randomized controlled studies comparing intravenous propofol and ketamine to any other single or combination drug regimen administered to children undergoing diagnostic or therapeutic procedures. Meta-analyses were performed for primary (hemodynamic and respiratory adverse events) and secondary outcomes using RevMan 5.3. We assessed the risk of bias and the certainty (quality) evidence for all outcomes using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. RESULTS: Twenty-nine studies were included for analysis. Based on low-to-moderate quality evidence, we concluded that the use of propofol and ketamine may result in a slight-to-small reduction in the risk of hypotension, bradycardia, and apnea, and a slight increase in the risk of tachycardia, hypertension, and other respiratory adverse events, such as cough or laryngospasm. The ratio of propofol to ketamine and comparator drug regimen subgroups effects were important for desaturation and some secondary outcomes. CONCLUSIONS: The use of propofol and ketamine had a minimal effect on the incidence of adverse events and other secondary outcomes. Large-scale studies are required to more accurately estimate adverse event rates and the effects of propofol and ketamine on patient-important outcomes.
Assuntos
Anestésicos Combinados/uso terapêutico , Anestésicos Dissociativos/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Sedação Consciente , Estado de Consciência/efeitos dos fármacos , Sedação Profunda , Hipnóticos e Sedativos/uso terapêutico , Ketamina/uso terapêutico , Propofol/uso terapêutico , Adolescente , Fatores Etários , Anestésicos Combinados/efeitos adversos , Anestésicos Dissociativos/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Criança , Pré-Escolar , Sedação Consciente/efeitos adversos , Sedação Profunda/efeitos adversos , Feminino , Humanos , Hipnóticos e Sedativos/efeitos adversos , Lactente , Recém-Nascido , Ketamina/efeitos adversos , Masculino , Propofol/efeitos adversos , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Ketamine is a versatile analgesic that has become an increasingly popular recreational drug. Chronic ketamine use has been found to cause biliary duct damage and bladder dysfunction. Ketamine-induced cholangiopathy and ulcerative cystitis are uncommon diagnoses presenting with nonspecific symptoms, creating diagnostic challenges for emergency physicians. We report a case of a teenage patient with the rare simultaneous presentation of ketamine-induced cholangiopathy and ulcerative cystitis. Due to increased recreational and chronic ketamine use, cases of ketamine-induced cholangiopathy and ulcerative cystitis are likely to rise with the increased knowledge, awareness, and reporting of these entities by radiologists and emergency physicians.
Assuntos
Anestésicos Dissociativos/efeitos adversos , Colangite/induzido quimicamente , Cistite/induzido quimicamente , Ketamina/efeitos adversos , Adolescente , Anestésicos Dissociativos/farmacologia , Colangite/diagnóstico por imagem , Colangite/patologia , Cistite/diagnóstico por imagem , Cistite/patologia , Humanos , Ketamina/farmacologia , Masculino , Uso Recreativo de DrogasAssuntos
Anestésicos Dissociativos/efeitos adversos , COVID-19/complicações , Colangite Esclerosante/induzido quimicamente , Ketamina/efeitos adversos , Sistema Biliar/diagnóstico por imagem , Sistema Biliar/patologia , Colangite Esclerosante/diagnóstico por imagem , Colangite Esclerosante/etiologia , Colangite Esclerosante/patologia , Sedação Consciente/efeitos adversos , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Inguinal herniotomy is one of the commonest paediatric surgical procedures at the University of Benin Teaching Hospital. Incisional infiltration with plain bupivacaine has been used to provide postoperative analgesia for this procedure but with a short duration of action, 4-6 hours. AIMS/OBJECTIVES: The aim of this study therefore was to evaluate the efficacy of subcutaneous ketamine on post-operative analgesia in children undergoing unilateral inguinal herniotomy. METHODS: Forty-six (46) ASA I or II patients aged three to seven years scheduled for unilateral inguinal herniotomy were recruited. The patients were randomized to receive surgical wound site infiltration with plain bupivacaine plus subcutaneous injection of ketamine for group I or surgical wound site infiltration plain bupivacaine plus 2ml of saline subcutaneously for group II at the end of surgery. Data obtained were analyzed using SPSS version 20. Continuous data were compared using student t-test while categorical data were compared using Chi-square or Fisher's exact test. P-value <0.05 was considered statistically significant. RESULTS: In group, I, the mean time to first analgesic request was 667.7 minutes (11.12 hours) and in group II, it was 371.3 minutes (6.2 hours) with p<0.001. The pain scores were better and more favourable in group I from the 8th hour and above of the assessment period. The mean post-operative analgesic consumption in 24 hours was less in group I (19.35±5.4mg) than in group II (27.32±5.8 mg) with p-value <0.001. CONCLUSION: The study showed that subcutaneous ketamine prolonged the analgesic effect of plain bupivacaine surgical wound site infiltration in children undergoing unilateral inguinal herniotomy.