Ketamine Continuous Infusions in Critically Ill Infants and Children

Golding, Charles L.; Miller, Jamie L.; Gessouroun, Morris; Johnson, Peter N.

doi:10.1177/1060028015626932

Cited by 34 publications

(32 citation statements)

References 24 publications

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“…The most frequently observed adverse effects associated with ketamine when used for maintenance sedation include arrhythmias (6.7%), hypertension (6%), paradoxical agitation (up to 20%), hypersalivation (12%), and nystagmus (up to 63%) . Although limited literature is available in adults, as many as 57% of pediatric patients who receive ketamine for continuous sedation experience emergence phenomenon, where they experience vivid hallucinations and delirium during or after ketamine use . When ketamine is used for procedural sedation in adults, up to 20% of patients may develop emergence phenomena .…”

mentioning

confidence: 99%

Impact of Ketamine Use on Adjunctive Analgesic and Sedative Medications in Critically Ill Trauma Patients

et al. 2017

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Although the use of ketamine in critically ill mechanically ventilated adult trauma patients was associated with decreased opioid use, it was also associated with increased use of dexmedetomidine and ziprasidone to achieve and maintain sedation. Further examination of clinical outcomes associated with these differences in drug use in a larger population of trauma patients is warranted before routine use of ketamine for analgesia and sedation can be recommended.

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confidence: 99%

Impact of Ketamine Use on Adjunctive Analgesic and Sedative Medications in Critically Ill Trauma Patients

et al. 2017

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“…This study did not take into account withdrawal symptoms from discontinuation of other medications such as benzodiazepines and barbiturates. Though sedative and analgesic regimens with ketamine and dexmedetomidine could theoretically lower the risk for withdrawal[23,24], none of our patients received either of these medications. The findings of this single center study may not be generalizable to other institutions.…”

Section: Discussionmentioning

confidence: 99%

Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children

Srinivasan¹,

Pung²,

O’Neill³

2017

WJCP

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AIMTo describe our institutional experience with conversion from intravenous (IV) fentanyl infusion directly to enteral methadone and occurrence of withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation and analgesia.METHODSWith Institutional Review Board approval, we retrospectively studied consecutively admitted invasively mechanically ventilated children (0-18 years) sedated with IV fentanyl infusion > 5 d and subsequently converted directly to enteral methadone. Data were obtained on subject demographics, illness severity, daily IV fentanyl and enteral methadone dosing, time to complete conversion, withdrawal scores (WAT-1), pain scores, and need for rescue opioids. Patients were classified as rapid conversion group (RCG) if completely converted ≤ 48 h and slow conversion group (SCG) if completely converted in > 48 h. Primary outcome was difference in WAT-1 scores at 7 d. Secondary outcomes included differences in overall pain scores, and differences in daily rescue opioids.RESULTSCompared to SCG (n = 21), RCG (n = 21) had lower median WAT-1 scores at 7 d (2.5 vs 5, P = 0.027). Additionally, RCG had lower overall median pain scores (3 vs 6, P = 0.007), and required less median daily rescue opioids (3 vs 12, P = 0.003) than SCG. The starting daily median methadone dose was 2.3 times the daily median fentanyl dose in the RCG, compared to 1.1 times in the SCG (P = 0.049).CONCLUSIONWe observed wide variation in conversion from IV fentanyl infusion directly to enteral methadone and variability in withdrawal in critically ill mechanically ventilated children exposed to prolonged sedation. In those children who converted successfully from IV fentanyl infusion to enteral methadone within a period of 48 h, a methadone:fentanyl dose conversion ratio of approximately 2.5:1 was associated with less withdrawal and reduced need for rescue opioids.

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“…Ketamine is contraindicated for patients with a raised intracranial pressure as ketamine may further increase the pressure by intracerebral vasodilation. The blocking of the NMDA receptor may prevent opioid tolerance; therefore, ketamine often serves as an adjunct to sedatives and opioid analgesics, with an opioid‐sparing effect . Ketamine is available as the racemic mixture of R(−) and S(+) ketamine, but the S(+) enantiomer is twice as potent as racemic ketamine and has fewer side effects .…”

Section: Pharmacological Agentsmentioning

confidence: 99%

Pharmacological sedation management in the paediatric intensive care unit

Baarslag

Allegaert

Knibbe

et al. 2017

Journal of Pharmacy and Pharmacology

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The population in question is very heterogeneous and this overview can aid clinicians and researchers in moving from practice-based sedation management towards more evidence- or model-based practice. Still, paediatric sedation management can be improved in other ways than pharmacology only, so future research should aim on sedation assessment and implementation strategies of protocolized sedation as well.

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Ketamine Continuous Infusions in Critically Ill Infants and Children

Abstract: Limited evidence was noted, so ketamine CINs could be considered an adjunct therapy at this time. Further prospective studies should be conducted to determine ketamine's role in sedation and analgesia, withdrawal treatment, and bronchospasm treatment.

Cited by 34 publications

References 24 publications

Impact of Ketamine Use on Adjunctive Analgesic and Sedative Medications in Critically Ill Trauma Patients

Impact of Ketamine Use on Adjunctive Analgesic and Sedative Medications in Critically Ill Trauma Patients

Conversion from prolonged intravenous fentanyl infusion to enteral methadone in critically ill children

Pharmacological sedation management in the paediatric intensive care unit

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