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Wehrman JJ, Chung CC, Sanders R. Anaesthetics and time perception: A review. Q J Exp Psychol (Hove) 2024; 77:1898-1910. [PMID: 36453756 DOI: 10.1177/17470218221144614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Consciousness requires subjective experience in the "now." Establishing "now," however, necessitates temporal processing. In the current article, we review one method of altering consciousness, anaesthetic drug administration, and its effects on perceived duration. We searched PubMed, PsycInfo, and ScienceDirect databases, and article reference sections, for combinations of anaesthetic drugs and time perception tasks, finding a total of 36 articles which met our inclusion criteria. We categorised these articles with regard to whether they altered the felt passage of time, short or long interval timing, or were motor timing tasks. We found that various drugs alter the perceived passage of time; ketamine makes time subjectively slow down while GABAergic drugs make time subjectively speed up. At a short interval there is little established evidence of a shift in time perception, though temporal estimates appear more variable. Similarly, when asked to use time to optimise responses (i.e., in motor timing tasks), various anaesthetic agents make timing more variable. Longer durations are estimated as lasting longer than their objective duration, though there is some variation across articles in this regard. We conclude by proposing further experiments to examine time perception under altered states of consciousness and ask whether it is possible to perceive the passage of time of events which do not necessarily reach the level of conscious perception. The variety of methods used raises the need for more systematic investigations of time perception under anaesthesia. We encourage future investigations into the overlap of consciousness and time perception to advance both fields.
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Affiliation(s)
| | - Clara C Chung
- Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Iacopino S, Filannino P, Artale P, Petretta A, Colella J, Statuto G, Di Vilio A, Dini D, Mantovani L, Rago A, Sorrenti PF, Fabiano G, Campagna G, Fabiano E, Malacrida M, Cecchini F. Investigating Deep Sedation With Intravenous Ketamine in Spontaneous Respiration During Pulsed-Field Ablation. J Cardiothorac Vasc Anesth 2024; 38:148-154. [PMID: 37953172 DOI: 10.1053/j.jvca.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The authors report their experience of a protocol for deep sedation with ketamine in spontaneous respiration during the pulsed-field ablation (PFA) of atrial fibrillation (AF). DESIGN Observational, prospective, nonrandomized fashion. SETTING Single-center hospitalized patients. PARTICIPANTS All consecutive patients undergoing PFA of AF. INTERVENTIONS Patients undergoing deep sedation with intravenous ketamine. MEASUREMENTS AND MAIN RESULTS The authors' sedation protocol involves the intravenous administration of fentanyl (1.5 µg/kg) and midazolam (2 mg) at low doses before local anesthesia with lidocaine. A ketamine adjunct (1 mg/kg) in 5-minute boluses was injected about 5 minutes before the first PFA delivery. The authors enrolled 117 patients (age = 59 ± 10 y, 74.4% males, body mass index = 27.6 ± 5 kg/m2, fluoroscopy time = 24 ± 14 minutes, skin-to-skin time = 80 ± 40 minutes and PFA LA dwell time = 24 ± 7 minutes). By the end of the procedure, pulmonary vein isolation had been achieved in all patients using PFA alone. The mean time under sedation was 54.9 ± 6 minutes, with 92 patients (79%) being sedated for <1 hour. A satisfactory Ramsay Sedation Scale level before ketamine administration was achieved in all patients, except one (80.3% of the patients with rank 3; 18.4% with rank 2). In all procedures, the satisfaction level was found acceptable by both the patient and the primary operator (satisfactory in 98.2% of cases). All patients achieved a Numeric Rating Scale for Pain ≤3 (none or mild). No major procedure or anesthesia-related complications were reported. CONCLUSION The authors' standardized sedation protocol with the administration of drugs with rapid onset and pharmacologic offset at low doses was safe and effective, with an optimal degree of patient and operator satisfaction.
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Guo J, Qiu D, Gu HW, Wang XM, Hashimoto K, Zhang GF, Yang JJ. Efficacy and safety of perioperative application of ketamine on postoperative depression: A meta-analysis of randomized controlled studies. Mol Psychiatry 2023; 28:2266-2276. [PMID: 36670198 PMCID: PMC10611576 DOI: 10.1038/s41380-023-01945-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/28/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023]
Abstract
Ketamine, a commonly used general anesthetic, can produce rapid and sustained antidepressant effect. However, the efficacy and safety of the perioperative application of ketamine on postoperative depression remains uncertain. We performed a meta-analysis to determine the effect of perioperative intravenous administration of ketamine on postoperative depression. Randomized controlled trials comparing ketamine with placebo in patients were included. Primary outcome was postoperative depression scores. Secondary outcomes included postoperative visual analog scale (VAS) scores for pain and adverse effects associated with ketamine. Fifteen studies with 1697 patients receiving ketamine and 1462 controls were enrolled. Compared with the controls, the ketamine group showed a reduction in postoperative depression scores, by a standardized mean difference (SMD) of -0.97, 95% confidence interval [CI, -1.27, -0.66], P < 0.001, I2 = 72% on postoperative day (POD) 1; SMD-0.65, 95% CI [-1.12, -0.17], P < 0.001, I2 = 94% on POD 3; SMD-0.30, 95% CI [-0.45, -0.14], P < 0.001, I2 = 0% on POD 7; and SMD-0.25, 95% CI [-0.38, -0.11], P < 0.001, I2 = 59% over the long term. Ketamine reduced VAS pain scores on POD 1 (SMD-0.93, 95% CI [-1.58, -0.29], P = 0.005, I2 = 97%), but no significant difference was found between the two groups on PODs 3 and 7 or over the long term. However, ketamine administration distinctly increased the risk of adverse effects, including nausea and vomiting (risk ratio [RR] 1.40, 95% CI [1.12, 1.75], P = 0.003, I2 = 30%), headache (RR 2.47, 95% CI [1.41, 4.32], P = 0.002, I2 = 19%), hallucination (RR 15.35, 95% CI [6.24, 37.34], P < 0.001, I2 = 89%), and dizziness (RR 3.48, 95% CI [2.68, 4.50], P < 0.001, I2 = 89%) compared with the controls. In conclusion, perioperative application of ketamine reduces postoperative depression and pain scores with increased risk of adverse effects.
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Affiliation(s)
- Jie Guo
- Department of Anesthesiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Di Qiu
- Department of Anesthesiology, Pain and Perioperative Medicine, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Han-Wen Gu
- Department of Anesthesiology, Pain and Perioperative Medicine, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xing-Ming Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan
| | - Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, 260-8670, Japan.
| | - Guang-Fen Zhang
- Department of Anesthesiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
| | - Jian-Jun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Chamadia S, Gitlin J, Mekonnen J, Ethridge BR, Ibala R, Colon KM, Qu J, Akeju O. Ketamine induces EEG oscillations that may aid anesthetic state but not dissociation monitoring. Clin Neurophysiol 2021; 132:3010-3018. [PMID: 34715426 DOI: 10.1016/j.clinph.2021.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/21/2021] [Accepted: 08/29/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Ketamine is an anesthetic drug associated with dissociation. Decreased electroencephalogram alpha (8-13 Hz) and low-beta (13-20 Hz) oscillation power have been associated with ketamine-induced dissociation. We aimed to characterize surface electroencephalogram signatures that may serve as biomarkers for dissociation. METHODS We analyzed data from a single-site, open-label, high-density surface electroencephalogram study of ketamine anesthesia (2 mg/kg, n = 15). We assessed dissociation longitudinally using the Clinician Administered Dissociation States Scale (CADSS) and administered midazolam to attenuate dissociation and enable causal inference. We analyzed electroencephalogram power and global coherence with multitaper spectral methods. Mixed effects models were used to assess whether power and global coherence signatures of ketamine could be developed into dissociation-specific biomarkers. RESULTS Compared to baseline, ketamine unresponsiveness was associated with increased frontal power between 0.5 to 9.3 Hz, 12.2 to 16.6 Hz, and 24.4 to 50 Hz. As subjects transitioned into a responsive but dissociated state (mean CADSS ± SD, 22.1 ± 17), there was a decrease in power between 0.5 to 10.3 Hz and 11.7 to 50 Hz. Midazolam reduced dissociation scores (14.3 ± 11.6), decreased power between 4.4 to 11.7 Hz and increased power between 14.2 to 50 Hz. Our mixed-effects model demonstrated a quadratic relationship between time and CADSS scores. When models (frontal power, occipital power, global coherence) were reanalyzed with midazolam and electroencephalogram features as covariates, only midazolam was retained. CONCLUSIONS Ketamine is associated with structured electroencephalogram power and global coherence signatures that may enable principled anesthetic state but not dissociation monitoring. SIGNIFICANCE A neurophysiological biomarker for dissociation may lead to a better understanding of neuropsychiatric disorders.
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Affiliation(s)
- Shubham Chamadia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jacob Gitlin
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Mekonnen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Breanna R Ethridge
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Reine Ibala
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Katia M Colon
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jason Qu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Oluwaseun Akeju
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Bates MLS, Trujillo KA. Use and abuse of dissociative and psychedelic drugs in adolescence. Pharmacol Biochem Behav 2021; 203:173129. [PMID: 33515586 DOI: 10.1016/j.pbb.2021.173129] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/26/2022]
Abstract
Adolescence is a period of profound developmental changes, which run the gamut from behavioral and neural to physiological and hormonal. It is also a time at which there is an increased propensity to engage in risk-taking and impulsive behaviors like drug use. This review examines the human and preclinical literature on adolescent drug use and its consequences, with a focus on dissociatives (PCP, ketamine, DXM), classic psychedelics (LSD, psilocybin), and MDMA. It is the case for all the substances reviewed here that very little is known about their effects in adolescent populations. An emerging aspect of the literature is that dissociatives and MDMA produce mixed reinforcing and aversive effects and that the balance between reinforcement and aversion may differ between adolescents and adults, with consequences for drug use and addiction. However, many studies have failed to directly compare adults and adolescents, which precludes definitive conclusions about these consequences. Other important areas that are largely unexplored are sex differences during adolescence and the long-term consequences of adolescent use of these substances. We provide suggestions for future work to address the gaps we identified in the literature. Given the widespread use of these drugs among adolescent users, and the potential for therapeutic use, this work will be crucial to understanding abuse potential and consequences of use in this developmental stage.
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Affiliation(s)
- M L Shawn Bates
- Department of Psychology, California State University Chico, 400 W. First St, Chico, CA 95929, USA.
| | - Keith A Trujillo
- Department of Psychology and Office for Training, Research and Education in the Sciences (OTRES), California State University San Marcos, 333 S. Twin Oaks Valley Rd, San Marcos, CA 92096, USA..
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6
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Abstract
BACKGROUND Ketamine is a dissociative anesthetic with analgesic properties. Ketamine's analgesic properties have been suggested to result from its dissociative properties. To the authors' knowledge, this postulate is unsubstantiated. The authors hypothesize that the dissociative and analgesic properties of ketamine are independent. METHODS The authors conducted a single-site, open-label study of ketamine anesthesia (2 mg/kg) in 15 healthy subjects. Midazolam was administered at a prespecified time point to attenuate dissociation. The authors longitudinally assessed precalibrated cuff pain intensity and quality using Patient-Reported Outcomes Measurement Information System questionnaires, and dissociation, using the Clinician Administered Dissociative States Scale. Mixed effects models were used to assess whether dissociation accounted for the effect of ketamine on pain intensity and quality. RESULTS The dissociation model demonstrated an inverted U-shaped quadratic relationship between time and dissociation scores. Additive to this effect, midazolam reduced the dissociation adjusted means by 10.3 points (95% CI, 3.4 to 17.1; P = 0.005). The pain intensity model also demonstrated a U-shaped quadratic relationship between time and pain intensity. When the pain intensity model was reanalyzed with dissociation scores as an additional covariate, the dissociation term was not retained in the model, and the other effects were preserved in direction and strength. This result was conserved for nociceptive and neuropathic pain quality. CONCLUSIONS Ketamine's analgesic properties are not exclusively caused by dissociation. Thus, ketamine may be used as a probe to advance our knowledge of dissociation independent neural circuits that encode pain. EDITOR’S PERSPECTIVE
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Rai A, Meng H, Weinrib A, Englesakis M, Kumbhare D, Grosman-Rimon L, Katz J, Clarke H. A Review of Adjunctive CNS Medications Used for the Treatment of Post-Surgical Pain. CNS Drugs 2017; 31:605-615. [PMID: 28577135 DOI: 10.1007/s40263-017-0440-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Inadequate post-operative pain management can have significant impacts on patients' quality of life. Effective management of acute pain after surgery is important for early mobilization and discharge from hospital, patient satisfaction, and overall well-being. Utilizing multimodal analgesic strategies has become the mainstay of acute post-operative pain management. A comprehensive search was performed, assessing the published or otherwise publically available literature on different central nervous system (CNS) drugs [excluding opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and acetaminophen] and their uses to treat acute post-surgical pain. Included among the drugs evaluated in this review are anticonvulsants, N-methyl-D-aspartic acid (NMDA) agonists, local anesthetics, α2-agonists, cannabinoids, serotonin-noradrenaline reuptake inhibitors (SNRIs), and serotonin-noradrenaline-dopamine reuptake inhibitors (SNDRIs). Timing, dosing, routes of administration, as well as mechanisms of action are discussed for these CNS drugs.
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Affiliation(s)
- Ajit Rai
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 3 EB-317, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Howard Meng
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 3 EB-317, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.,Department of Anesthesia, University of Toronto, RM 1200, 12th floor, 123 Edward St., Toronto, Ontario, M5G 1E2, Canada
| | - Aliza Weinrib
- Department of Anesthesia, University of Toronto, RM 1200, 12th floor, 123 Edward St., Toronto, Ontario, M5G 1E2, Canada.,Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.,Department of Psychology, York University, 4700, Keele St., BSB 232, Toronto, ON, M3J 1P3, Canada
| | - Marina Englesakis
- Library and Information Services, Toronto General HospitalUniversity Health Network, 1 EN-418, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Dinesh Kumbhare
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Liza Grosman-Rimon
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Joel Katz
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 3 EB-317, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.,Department of Anesthesia, University of Toronto, RM 1200, 12th floor, 123 Edward St., Toronto, Ontario, M5G 1E2, Canada.,Department of Psychology, York University, 4700, Keele St., BSB 232, Toronto, ON, M3J 1P3, Canada
| | - Hance Clarke
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 3 EB-317, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada. .,Department of Anesthesia, University of Toronto, RM 1200, 12th floor, 123 Edward St., Toronto, Ontario, M5G 1E2, Canada. .,Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada.
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8
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Abstract
One of the most fascinating drugs in the anesthesiologist's armament is ketamine, an N-methyl-D-aspartate receptor antagonist with a myriad of uses. The drug is a dissociative anesthetic and has been used more often as an analgesic in numerous hospital units, outpatient pain clinics, and in the prehospital realm. It has been used to treat postoperative pain, chronic pain, complex regional pain syndrome, phantom limb pain, and other neuropathic conditions requiring analgesia. Research has also demonstrated its efficacy as an adjunct in psychotherapy, as a treatment for both depression and posttraumatic stress disorder, as a procedural sedative, and as a treatment for respiratory and neurologic conditions. Ketamine is not without its adverse effects, some of which can be mitigated with certain efforts. Such effects make it necessary for the clinician to use the drug only in situations where it will provide the greatest benefit with the fewest adverse effects. To the best of our knowledge, none of the reviews regarding ketamine have taken a comprehensive look at the drug's uses in all territories of medicine. This review will serve to touch on its chemical data, pharmacokinetics and pharmacodynamics, medical uses, and adverse effects while focusing specifically on the drugs usage in anesthesia and analgesia.
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Li Q, Yang D, Liu J, Zhang H, Zhang J. Intravenous Lipid Emulsion Improves Recovery Time and Quality from Isoflurane Anaesthesia: A Double-Blind Clinical Trial. Basic Clin Pharmacol Toxicol 2014; 115:222-8. [PMID: 24612915 DOI: 10.1111/bcpt.12223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 02/11/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Qian Li
- Department of Anesthesiology and Translational Neuroscience Center; West China Hospital of Sichuan University; Chengdu China
| | - Di Yang
- Department of Anesthesiology and Translational Neuroscience Center; West China Hospital of Sichuan University; Chengdu China
| | - Jin Liu
- Department of Anesthesiology and Translational Neuroscience Center; West China Hospital of Sichuan University; Chengdu China
| | - Han Zhang
- Department of Anesthesiology and Translational Neuroscience Center; West China Hospital of Sichuan University; Chengdu China
| | - Jingyu Zhang
- Department of Anesthesiology and Translational Neuroscience Center; West China Hospital of Sichuan University; Chengdu China
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Unique Clinical Situations in Pediatric Patients Where Ketamine may be the Anesthetic Agent of Choice. Am J Ther 2010; 17:511-5. [DOI: 10.1097/mjt.0b013e3181ddc984] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The Early and Delayed Analgesic Effects of Ketamine After Total Hip Arthroplasty: A Prospective, Randomized, Controlled, Double-Blind Study. Anesth Analg 2009; 109:1963-71. [DOI: 10.1213/ane.0b013e3181bdc8a0] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Remerand F, Couvret C, Pourrat X, Le Tendre C, Baud A, Fusciardi J. [Prevention of psychedelic side effects associated with low dose continuous intravenous ketamine infusion]. Therapie 2008; 62:499-505. [PMID: 18316016 DOI: 10.2515/therapie:200802] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Continuous low dose infusion of intravenous ketamine for postoperative analgesia was often associated with frightening acute psychodysleptic experiences in our patients. We hypothesized they were due to boluses of ketamine accumulated in the infusion line. We evaluated on two successive groups the impact of perfusion line modifications on psychodysleptic side effects occurrence. METHODS We compared a reference historic group (in which ketamine line was connected to perfusion line) to a second prospective group (in which ketamine line was connected to the venous catheter via an unidirectional valve). RESULTS Psychodysleptic experiences occurrence decreased from 4 patients of 26 (15%) to 2 of 116 (2%, p = 0.01). Moreover, these experiences were no longer associated with severe anxious symptoms like near death experiences. CONCLUSION An unidirectional valve must be considered to limit the occurrence of low dose intravenous ketamine infusion associated psychedelic side effects, during postoperative analgesia.
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Affiliation(s)
- Francis Remerand
- Groupement d'Anesthésie Réanimation, Hôpital Trousseau, CHU de Tours, Tours, France.
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Erk G, Ornek D, Dönmez NF, Taşpinar V. The use of ketamine or ketamine-midazolam for adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2007; 71:937-41. [PMID: 17418428 DOI: 10.1016/j.ijporl.2007.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 03/02/2007] [Accepted: 03/03/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ketamine's role in clinical anaesthesia is developing as a result of the evolving concepts of its mechanism of action and the advantages of its alternative routes of administration. In this study, we aimed to investigate the frequency and severity of adverse effects, specifically emergence phenomena and vomiting, when ketamine with or without midazolam used as a sole anaesthetic. METHODS One hundred children, aged between 3 and 10 years, scheduled for adenotonsillectomy were studied. Fifty ASA physical status I-II patients were administered ketamine and atropine intramuscularly (group K, n=50). The remaining 50 children were given ketamine, atropine and midazolam by as the same route (group KM, n=50). Noninvasive hemodynamic and oxygenation variables were monitored. Operative conditions and recovery profiles such as hallucinations, nightmares, awakening by crying agitation and retching-vomiting were investigated in 1st, 2nd, 15th, 30th and 60th days after the operation. RESULTS A significant reduction in emergence reactions was demonstrated especially in group KM during the early postoperative period (p<0.05). Retching-vomiting also reduced significantly in the group KM during the same time (p<0.05). CONCLUSION As a sole anaesthetic ketamine with or without midazolam provided a calm and safe anaesthesia for paediatric patients in short term procedures. In addition, it must be noted that, a better postoperative early period was achieved by ketamine with midazolam.
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Affiliation(s)
- Gülcan Erk
- Department of Anaesthesiology and Reanimation, Ankara Numune Training and Research State Hospital, Turkey.
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Dorandeu F, Carpentier P, Baubichon D, Four E, Bernabé D, Burckhart MF, Lallement G. Efficacy of the ketamine-atropine combination in the delayed treatment of soman-induced status epilepticus. Brain Res 2005; 1051:164-75. [PMID: 16005443 DOI: 10.1016/j.brainres.2005.06.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 06/03/2005] [Accepted: 06/07/2005] [Indexed: 10/25/2022]
Abstract
Nerve agent poisoning is known to induce full-blown seizures, seizure-related brain damage (SRBD), and lethality. Effective and quick management of these seizures is critical. In conditions of delayed treatment, presently available measures are inadequate calling for optimization of therapeutic approaches. The effects of ketamine/atropine sulfate (KET/AS) combinations were thus assessed as potential valuable delayed therapy in soman-poisoned male guinea pigs. Animals received pyridostigmine (26 microg/kg, i.m.) 30 min before soman (62 microg/kg, i.m.) followed by therapy consisting of atropine methyl nitrate (4 mg/kg) 1 min later. KET was then administered i.m. at different times after the onset of seizures, starting at 30 min post-poisoning. KET was always injected with atropine sulfate, itself given at a dose that was unable to modify seizures (2 to 10 mg/kg). Different treatment schemes (dose and time of injection) were evaluated. Sub-anesthetic doses of KET (10 mg/kg) could prevent lethality and stop ongoing seizures only when administered 30 min after challenge. An extended delay before treatment (up to 2 h) called for an increase in KET dose (up to 60 mg/kg three times), thus reaching anesthetic levels but without the need of any ventilation support. KET proved effective in stopping seizures, highly reducing SRBD and allowing survival with a progressive loss of efficacy when treatment was delayed beyond 1 h post-challenge. Preliminary results suggest that association with the benzodiazepine midazolam (1 mg/kg) might be interesting when treatment is initiated 2 h after poisoning, i.e., when KET efficacy is dramatically reduced. All in all, these observations suggest that KET, in association with atropine sulfate and possibly other drugs, may be highly effective in the delayed treatment of severe soman intoxication.
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Affiliation(s)
- Frederic Dorandeu
- Département de Toxicologie, CRSSA, 24 avenue des Maquis du Gresivaudan, F-38 702 La Tronche, France.
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Chua MV, Tsueda K, Doufas AG. Midazolam causes less sedation in volunteers with red hair. Can J Anaesth 2004; 51:25-30. [PMID: 14709456 DOI: 10.1007/bf03018542] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE We studied sedation, cognition, and mood during midazolam infusion in volunteers with red and non-red (blond or brown) hair, to test the hypothesis that patients with red hair may require more drugs to attain desired levels of sedation. METHODS Twenty red and 19 non-red hair subjects were studied in a randomized, placebo-controlled cross-over design. Subjects were studied during placebo and midazolam at 30 ng.mL(-1) target effect site concentration. Sedation was assessed using the observer's assessment of alertness/sedation (OAA/S) scale, the drowsiness visual analogue scale (VAS), and the bispectral index; cognition was assessed using the Repeatable Battery for Assessment of Neuropsychological Status; and mood was assessed using the bipolar form of the Profile of Mood States (POMS). RESULTS Red hair volunteers showed significantly higher OAA/S (P < 0.01) and lower drowsiness VAS (P < 0.05) scores compared to non-red hair subjects during midazolam infusion. Visuospatial score was significantly higher in subjects with red compared to non-red hair during placebo and midazolam trials. Delayed memory score was significantly higher during midazolam infusion in subjects with red compared to non-red hair. There were no group differences in POMS during either trials. CONCLUSION Midazolam appears to cause significantly less sedation and cognitive impairment in red haired subjects.
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Affiliation(s)
- Marlene V Chua
- Department of Anesthesiology and the Outcomes Research Institute, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA
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16
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Morse Z, Kaizu M, Sano K, Kanri T. BIS monitoring during midazolam and midazolam-ketamine conscious intravenous sedation for oral surgery. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 94:420-4. [PMID: 12374913 DOI: 10.1067/moe.2002.127587] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether the bispectral index scale (BIS) would provide added benefit to established methods of monitoring conscious sedation with midazolam (M group) or midazolam supplemented with ketamine (MK group). STUDY DESIGN BIS was prospectively and blindly examined in 22 patients receiving outpatient oral surgery with conscious sedation supplemented with local anesthesia. RESULTS The average midazolam dose in the midazolam group over the treatment period was 0.01 mg/kg/h, and the average midazolam plus ketamine dose was 0.01 and 0.05 mg/kg/h, respectively. Mean BIS values throughout the sedation study period were 90 for the midazolam group and 94 for the midazolam plus ketamine group. The addition of ketamine did not lower BIS. BIS values did not alter significantly over time except for an expected transient drop after the midazolam bolus induction. CONCLUSION BIS levels remained close to baseline levels, suggesting that BIS would not provided any additional benefit to currently established methods of monitoring patient consciousness during conscious sedation for oral surgery.
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Affiliation(s)
- Zac Morse
- Department of Anesthesiology, The Nippon Dental University at Niigata, Hamaura-cho, Japan.
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17
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Mortero RF, Clark LD, Tolan MM, Metz RJ, Tsueda K, Sheppard RA. The Effects of Small-Dose Ketamine on Propofol Sedation: Respiration, Postoperative Mood, Perception, Cognition, and Pain. Anesth Analg 2001; 92:1465-9. [PMID: 11375826 DOI: 10.1097/00000539-200106000-00022] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We compared the effects of coadministration of propofol and small-dose ketamine to propofol alone on respiration during monitored anesthesia care. In addition, mood, perception, and cognition in the recovery room, and pain after discharge were evaluated. In the Propofol group (n = 20), patients received propofol 38 +/- 24 microg x kg(-1) x min(-1). The Coadministration group (n = 19) received propofol 33 +/- 13 microg x kg(-1) x min(-1) and ketamine 3.7 +/- 1.5 microg x kg(-1) x min(-1). Respiration was assessed by using end-expiratory PCO(2) measurements at nasal prongs. After surgeries, mood, perception, and thought were assessed by using visual analog scales, and cognition was assessed by Mini-Mental State Examination (MMSE). Pain after discharge was assessed by a five-point rating scale in the evening for 5 days. End-expiratory PCO(2) was lower in the Coadministration group (P < 0.0001). Mood and MMSE scores were higher in the Coadministration group (P < 0.004 and P = 0.001, respectively). Pain scores and analgesic consumption after discharge were less in the Coadministration group (P = 0.0004 and P < 0.0001, respectively). We conclude that coadministration of small-dose ketamine attenuates propofol-induced hypoventilation, produces positive mood effects without perceptual changes after surgery, and may provide earlier recovery of cognition.
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Affiliation(s)
- R F Mortero
- Department of Anesthesiology, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA.
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