Clinical Uses of Low – Dose Ketamine in Patients Undergoing Surgery

Berti, Marco; Baciarello, Marco; Troglio, Raffaella; Fanelli, Guido

doi:10.2174/138945009788982496

Cited by 40 publications

(26 citation statements)

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“…Several other publications concerning perioperative use have appeared in the review period. Earlier results have been reaffirmed [65]; a single ketamine dose at induction has again been shown not to reduce postoperative morphine requirements [66], although preinduction administration of ketamine with clonidine seemed beneficial [67].…”

Section: Perioperative Usementioning

confidence: 95%

Wherefore ketamine?

Persson

2010

Current Opinion in Anaesthesiology

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Section: Perioperative Usementioning

confidence: 95%

Wherefore ketamine?

Persson

2010

Current Opinion in Anaesthesiology

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“…We hypothesized that nonsedating dose of 0.25 mg/kg of preincision ketamine would prolong the time to pain requiring treatment, based on ketamine's beneficial properties above and especially since studies showed its benefit as an adjuvant for postoperative analgesia in low-dose regimens ranges of 0.25–0.5 mg/kg [15]. We chose a randomized prospective controlled trial setting to study the twenty-four-hour (24-hour) postoperative analgesia effects when administered at preincision for elective Caesarean delivery performed under spinal anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

Mwase

Luggya

Kasumba

et al. 2017

Anesthesiology Research and Practice

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Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine's postoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.” Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group. Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry number PACTR201404000807178.

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“…The NMDA receptor plays a key role in a wide range of physiologic processes including synaptic plasticity [16] . NMDA receptor activity is modulated by endogenous compounds, such as zinc ions, polyamines and protons [17] , and is antagonized by various anaesthetics [18] and recreational drugs, including ethanol and phencyclidine [19,20] . The mGluRs perform a number of different functions in the central and peripheral nervous system: they are involved in learning, memory, anxiety and sensation of pain [21,22] .…”

Section: Introductionmentioning

confidence: 99%

The N-Methyl-<i>D</i>-Aspartic Acid Receptor Antagonist Memantine Ameliorates and Delays the Development of Arthritis by Enhancing Regulatory T Cells

et al. 2012

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The neuroendocrine impact on rheumatoid arthritis is not yet fully described although numerous neurotransmitters are shown to act as inflammatory modulators. One of these is the excitatory transmitter glutamate (Glu). In this study, the influence of the Glu receptor (GluR)-mediated effects on collagen-induced arthritis (CIA) was investigated. CIA was induced in DBA/1 mice by immunization with chicken collagen type II (CII). Mice were exposed to the following GluR antagonists: group 1, the N-methyl-D-aspartic acid (NMDA) receptor channel blocker memantine; group 2, the metabotropic GluR antagonist AIDA, and group 3, the excitatory amino acid receptor antagonist kynurenic acid (KA). Arthritis was evaluated clinically and histologically and compared to PBS-treated controls. The effects of treatment on T cell populations and the levels of anti-CII and anti-citrullinated peptide antibodies were evaluated. Memantine treatment significantly improved the course of CIA, reducing synovitis (p = 0.007) and the frequency of erosions (p = 0.007). Memantine treatment up-regulated the expression of Foxp3 in spleen CD4+ T cells followed by an increase in CD4+CD25+ regulatory T cells. The other GluR antagonists, AIDA and KA, had no effect on CIA. These results demonstrate that blockade of the NMDA receptor channel with memantine delays and attenuates the development of arthritis, probably by promoting the development of regulatory T lymphocytes.

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Clinical Uses of Low – Dose Ketamine in Patients Undergoing Surgery

Cited by 40 publications

References 0 publications

Wherefore ketamine?

Wherefore ketamine?

Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda’s Tertiary Hospital: A Randomized Clinical Trial

The N-Methyl-<i>D</i>-Aspartic Acid Receptor Antagonist Memantine Ameliorates and Delays the Development of Arthritis by Enhancing Regulatory T Cells

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