Ketamine for Long-Term Sedation and Analgesia of a Burn Patient

Edrich, Thomas; Friedrich, Andrew D.; Eltzschig, Holger K.; Felbinger, Thomas W.

doi:10.1213/01.ane.0000133002.42742.92

Cited by 33 publications

(14 citation statements)

References 18 publications

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“…There was an immediate (<10 min) significant (p<0.0001) decline in pain intensity in MK group patients. Thomas Edrich at al 2004 18 reported a burn case in which ketamine was successfully used for long term analgesia and sedation in patients who had developed tolerance to opioids.…”

Section: Resultsmentioning

confidence: 99%

Post-Operative Analgesia in Patients Undergoing Major Surgeries: Effect of Adding Iv Ketamine to Morphine in Presence of Morphine Resistant Pain

Mathew¹,

Rajkumar²,

Afzal³

et al. 2014

jemds

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Peri-operative management of opioid resistant pain is major clinical problem especially in the immediate postoperative period. The role of NMDA receptor in the processing of nociceptive input has lead naturally to renewed clinical interest in NMDA receptor antagonist such as ketamine. This paper reviews the use and efficacy of adding low dose ketamine to morphine in management of acute post-operative pain in patients who perceive pain in spite of large consumption of morphine and added advantages of decreasing opioid consumption and there by resulting in minimizing dose related side effects. We conducted a randomized double blind study on 120 patients undergoing major abdominal surgery. All patients were kept in PACU post operatively and were given basal analgesia with IV morphine till maximum of 100µg /kg within 30 min period, but if patient still complained of pain (≥6 of 10 on VAS) with an acceptable cognition state (≥15 in the MMSE) and who rated themselves not sedated (≥5 of 10 on VAS) were taken as resistant to morphine and were enrolled in one of the two treatment groups. The MS group received 3 boluses of 30 µg/kg of morphine plus saline whereas MK group received 3 boluses of 15 µg of morphine plus 250 µg/kg of ketamine. The total dose of morphine required by MK patients (0.42±0.12 mg/kg) was significantly less than MS patients (1.21±0.43mg/kg). (P<0.0001). The quality of analgesia was in favor of MK group even in terms of rescue analgesia as amount of diclofenac required was double in MS patients than in MK patients. (186.84 ± 37.83 vs. 83.57 ±30.28, P= 0.0001). The VAS score at rest and ambulation was significantly less in MK group as compared to MS group at 180 minutes (P<0.001). The 10 minute level of wakefulness (1-10 VAS) in the MS group (6.88±1.09) was significantly (P < 0.0001) less than MK group (8.28 ± 0.43). Postoperative nausea and vomiting was seen in 68.37% of MS patients as compared to only 8.30% of MK patients (P=0.0001). No hemodynamic ill effects or psychosomatic effects were seen in MK group. We concluded that the postoperative administration of concomitant small doses of MK provided rapid and sustained improvement in pain control in major abdominal surgeries.

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Section: Resultsmentioning

confidence: 99%

Post-Operative Analgesia in Patients Undergoing Major Surgeries: Effect of Adding Iv Ketamine to Morphine in Presence of Morphine Resistant Pain

Mathew¹,

Rajkumar²,

Afzal³

et al. 2014

jemds

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“…In these children, ketamine was weaned over a few days without side effects but the total daily doses administered were lower than in this case. Edrich et al reported an adult patient with burns who received ketamine for 24 days and was weaned over 2 days without withdrawal (7). In our hospital, we use ketamine infusions for children with mucositis (following bone marrow transplant) and routinely wean the infusion over 1-2 days after 10-14 days of treatment.…”

Section: Discussionmentioning

confidence: 99%

Long‐term use of an intravenous ketamine infusion in a child with significant burns

White

Karsli

2007

Pediatric Anesthesia

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We report the use of an intravenous ketamine infusion for 37 days in a 9-year-old child with 42% body surface area burns. Ketamine was administered both in the intensive care unit and the surgical ward and provided high quality analgesia as an opioid adjunct. Throughout the long duration of administration, the child did not develop tolerance or experience psychomimetic side effects and weaning of the ketamine infusion was achieved rapidly, without evidence of withdrawal. This case demonstrates the safe and effective use of long-term intravenous ketamine in a child with significant burns on a surgical ward. We have focused the discussion on the issues of tolerance and weaning of long-term ketamine infusions in children.

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“…Ketamine infusion has also been used successfully for long-term sedation and analgesia in a burn patient, with remarkable opioidsparing effects. 489 Its dissociative effects can be unpleasant for patients, however, and can lead to emergence delirium. Delirium may be attenuated by preemptive or rescue doses of midazolam or propofol.…”

Section: Nonopioid Analgesics In Patients With Burn Injurymentioning

confidence: 99%