Dissociative Conscious Sedation, An Alternative to General Anesthesia for Laparoscopic Peritoneal Dialysis Catheter Implantation: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine

Abstract

Dissociative conscious sedation is an acceptable alternative to general anesthesia in laparoscopic implantation of the PD catheter. Ketamine by the SC route is as effective as, but safer than, IV ketamine.

Evaluation of a Low Dose Ketamine in Post Tonsillectomy Pain Relief: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine in Pediatrics

“…Psychomimetic side effects have not been reported after rectal administration, which is known to result in low plasma levels (23). As shown in this study a subcutaneous injection might therefore provide analgesia without hallucinations or other psychomimetic effects (26). This study demonstrated no significant hemodynamic changes (heart rate and blood pressure) with ketamine administration.…”

“…at 60 and 360 minutes after the operation) more than IV ketamine injection(0.5 mg/kg). This effect is probably because of gradual absorption of ketamine in subcutaneous administration (26). Several advantages of S.C ketamine such as lower incidence of psychomimetic side effects have been documented by keeping the plasma concentration at 150ng/ ml and even lower (22).…”

Anesthesia Considerations for Insertion of the Peritoneal Dialysis Catheter

“…There was more co-morbidity in the LA group, a result of confounding by indication, since it was elected to use LA because of the higher risk for GA [9].…”

“…In addition, CO 2 is rapidly absorbed across the peritoneal membrane and may contribute to significant metabolic acidosis and cardiac arrhythmias [14,15], disturbances that are not well tolerated by high-risk renal failure patients [10]. Alternatively, N 2 O is an inert gas and better tolerated as an insufflation agent [16], because it produces neither peritoneal irritation nor the metabolic effects, offering a plausible explanation for absence of pain and thus enabling laparoscopy with the patient under local anesthesia [9,12]. Combined with the mild conscious sedation which is appropriate to alleviate undue fear and anxiety, the procedure can be tolerated well without GA [10].…”

“…One of the major drawbacks to the acceptance of laparoscopic insertion is the perceived necessity for General Anesthesia (GA), because insufflation of gas into the abdominal cavity produces peritoneal pain. Given that candidates for PD catheter implantation are patients with end-stage renal failure who often have severe coexisting medical problems that put them in a high-risk category for general anesthesia [9], the feasibility of laparoscopic implantation of PDC under local is worthy of investigation.…”