Ketamine as an adjunct to fentanyl improves postoperative analgesia and hastens discharge in children following tonsillectomy – a prospective, double‐blinded, randomized study

Elshammaa, Nabil; Chidambaran, Vidya; Housny, W; Thomas, Joan; Zhang, Xue; Michael, Rafik

doi:10.1111/j.1460-9592.2011.03604.x

Cited by 41 publications

(36 citation statements)

References 27 publications

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“…Another meta-analysis stated that caudal ketamine in pediatric patients was associated with decreased post-operative pain and nonopioid analgesic requirements [66] . When 0.5 mg/kg of ketamine was added to 1 mcg/kg fentanyl, analgesia improved without delaying hospital discharge after a tonsillectomy [67] . Additionally, 0.5 mg/kg ketamine with 5% sevoflurane and alfentanil 10 mcg/kg improved intubating conditions in children, while preserving spontaneous breathing and hemodynamic stability [68] .…”

Section: Pediatric Usementioning

confidence: 99%

Ketamine use in current clinical practice

2016

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After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

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Section: Pediatric Usementioning

confidence: 99%

Ketamine use in current clinical practice

2016

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“…In previous studies [4], [28], several scoring systems (OPS, CHEOPS, and pediatric behavioral FLACC pain scale as three examples) were used to assess pain by the clinicians to obtain more reliable results. These systems depend on the behavioural expression and/or verbal expression, and are sensitive for this population and validated measures of pain for children [4].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Ketamine in Improving Pain after Tonsillectomy in Children: Meta-Analysis

et al. 2014

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Background and objectivesThe goal of this meta-analysis study was to perform a systematic review of the literature on the effects of ketamine on postoperative pain following tonsillectomy and adverse effects in children.Subjects and MethodsTwo authors independently searched three databases (MEDLINE, SCOPUS, Cochrane) from their inception of article collection to February 2014. Studies that compared preoperative ketamine administration (ketamine groups) with no treatment (control group) or opioid administration (opioid group) where the outcomes of interest were postoperative pain intensity, rescue analgesic consumption, or adverse effects (sedation, nausea and vomiting, bad dream, worsening sleep pattern, and hallucination) 0–24 hours after leaving the operation room were included in the analysis.ResultsThe pain score reported by the physician during first 4 hours and need for analgesics during 24 hours postoperatively was significantly decreased in the ketamine group versus control group and was similar with the opioid group. In addition, there was no significant difference between ketamine and control groups for adverse effects during 24 hours postoperatively. In the subgroup analyses (systemic and local administration) regarding pain related measurements, peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity and need for analgesics.ConclusionPreoperative administration of ketamine systemically or locally could provide pain relief without side-effects in children undergoing tonsillectomy. However, considering the insufficient evaluation of efficacy of ketamine according to the administration methods and high heterogeneity in some parameters, further clinical trials with robust research methodology should be conducted to confirm the results of this study.

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“…Rather than increasing the dosage of propofol, propofol and remifentanil are combined with nonopioids such as paracetamol, novalgin, NSAIDs, and opioids such as sufentanil, alfentanil, fentanyl, morphine. Other drugs like ketamine, clonidine, and dexamethasone may also be useful adjuncts [38][39][40][41][42]. Regional anesthesia can be combined with TIVA and TCI anesthesia/sedation and provides excellent intraoperative and postoperative analgesia [43].…”

Section: Total Intravenous Anesthesia and Target-controlled Infusionmentioning

confidence: 99%

Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room

Er¹

2015

Current Opinion in Anaesthesiology

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Both anesthesiologists and nonanesthesiologists have to achieve a consensus and develop quality-improvement strategies to provide safe and efficient anesthesia and sedation for gastrointestinal procedures outside of the operating room for pediatric and adult patients. Techniques using TIVA, TCI, intravenous or topical application of lidocaine, and the video laryngoscope may improve and facilitate gastrointestinal procedures for the patients, the anesthesiologists, and the gastroenterologists.

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Ketamine as an adjunct to fentanyl improves postoperative analgesia and hastens discharge in children following tonsillectomy – a prospective, double‐blinded, randomized study

Abstract: We conclude that the administration of ketamine 0.5 mg·kg(-1) with 1 mcg·kg(-1) fentanyl in children undergoing tonsillectomy may improve postoperative pain control without delaying home discharge.

Cited by 41 publications

References 27 publications

Ketamine use in current clinical practice

Ketamine use in current clinical practice

Efficacy of Ketamine in Improving Pain after Tonsillectomy in Children: Meta-Analysis

Adult and pediatric anesthesia/sedation for gastrointestinal procedures outside of the operating room

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