Ketamine for Sickle Cell Vaso-Occlusive Crises

Alshahrani, Mohammed; Alghamdi, Mohannad

doi:10.4103/sjmms.sjmms_218_20

Cited by 12 publications

(5 citation statements)

References 40 publications

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“…It is also efficacious for postoperative pain relief after surgery for scoliosis in adolescents, as shown by a randomized control trial conducted by Minoshima et al on 36 patients aged 10 to 19 years [56]. It is also used to manage the pain crisis in sickle cell disease patients [57].…”

Section: Non-anesthetic Usesmentioning

confidence: 97%

Clinical Uses of Ketamine in Children: A Narrative Review

Bali¹,

Dang²,

Gonzalez³

et al. 2022

Cureus

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Ketamine is a phencyclidine derivative that acts as a noncompetitive N-methyl-D-aspartate as well as a glutamate receptor antagonist. It also has other minor mechanisms that contribute to its extensive drug profile. Ketamine is a bronchodilator and maintains normal airway reflexes and, thus, permits spontaneous respiration. This, coupled with the fact that it produces potent analgesia, makes it highly suitable for children.Despite its many merits, the drug's side effects, along with its cultural image of being a drug of abuse, a drug used in veterinary medicine, or a "date-rape drug" have sullied its reputation within the armamentarium of medicine. Even though it is widely used in developing countries, its use in Western nations has diminished. We have strived to explore the various clinical uses of ketamine in children through this article. In addition, the article also highlights how some of the fears associated with using the drug are unfounded and provides ways by which the drug's side effects can be prevented and managed.

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Section: Non-anesthetic Usesmentioning

confidence: 97%

Clinical Uses of Ketamine in Children: A Narrative Review

Bali¹,

Dang²,

Gonzalez³

et al. 2022

Cureus

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“…The current body of literature also includes meta-analysis publications that explored a single therapy, including all of the available evidence of any format for that specific given therapy. Examples include review studies that more deeply investigated crizanlizumab [ 21 ] and ketamine [ 22 ]. The crizanlizumab review ultimately analyzed only two of the 52 records that remained following duplicate removal.…”

Section: Introductionmentioning

confidence: 99%

Emerging Therapies for the Management of Pain and Vaso-Occlusive Crises in Patients With Sickle Cell Disease: A Systematic Review of Randomized Controlled Trials

Lowe¹,

Bambhroliya²,

Patel³

et al. 2023

Cureus

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Sickle cell disease (SCD) is an inherited disorder that impairs red blood cells (RBCs) and disrupts the delivery of oxygen to tissues. There is currently no cure. Symptoms can appear as early as six months of age and include anemia, acute episodes of pain, swelling, infections, delayed growth, and vision problems. A growing number of therapies are being investigated for reducing these episodes of pain, also known as vaso-occlusive crises (VOCs). The research literature evidence, however, currently includes far more approaches that have not shown superiority versus placebo than ones that have been proven effective. The purpose of this systematic review is to evaluate the body of randomized controlled trials (RCTs) to determine the quality of support for and against the use of a variety of current and emerging therapies for treading SCD VOCs. Several important new papers have emerged since previous systematic reviews with similar objectives were published. This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and focused on PubMed exclusively. Only RCTs were sought, and no other filters, except for a five-year historical timeline cut-off, were used. Of the 46 publications that were returned in response to the query, 18 were ultimately accepted as meeting the pre-established inclusion criteria. The Cochrane risk-of-bias tool was utilized as a quality assessment measure, and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework was used to assess the certainty of the evidence. Among the included publications, five out of 18 featured positive results with superiority and statistical significance versus placebo for either reduction in pain score or number/duration of VOCs. The approaches featured therapies ranging from de novo molecules to currently available drugs approved for other indications to naturally occurring metabolites such as amino acids and vitamins. A single therapy, arginine, was supported for both clinical endpoints: pain score reduction and shortened VOC duration. Currently, two therapies are approved by the United States Food and Drug Administration (FDA) and are commercially available (crizanlizumab, ADAKVEO and L-glutamine, Endari). All other therapies are investigational only in nature. Several studies included measurement of biomarker endpoints as well as clinical outcomes. Generally, beneficial outcomes related to improving biomarker levels did not also translate into statistically significant reduction of pain scores or number/duration of VOCs. While measuring biomarkers may contribute to the understanding of pathophysiology, it does not appear to directly offer predictive value toward treatment success clinically. It can be concluded that there exists a specific opportunity to design, fund, and execute investigations that both compare emerging and existing therapies versus one another and compare combinational therapies versus placebo.

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“…Indications for NSAIDs should be established for its use during VOC. Early use of ketamine should be studied: trials suggest its analgesic effect is comparable to morphine, 9 but adverse effects might be more frequent.…”

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confidence: 99%

Comprehensive assessment, pain and ventilatory management during acute complications of adult sickle cell disease: A clinical practice survey in French intensive care units

Hagry,

Monnet,

Mekontso‐Dessap

et al. 2024

Br J Haematol

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Painful vaso-occlusive crisis (VOC) and acute chest syndrome (ACS) 1 are the main complications of sickle cell disease (SCD) leading to ICU. The French Internal Medicine Society published guidelines 2 in 2015 without any intensivists' participation. Despite the frequent use of ICU resources, there may be heterogeneity in treatment and global management, likely because SCD is complex and often requires a multidisciplinary care. Moreover, the geographical distribution of patients with SCD is not homogeneous across the country, as the prevalence of this disease is higher in specific areas. Finally, there is a lack of ICU-specific guidelines for SCD. The aim of this study was to assess, nationwide, medical practices and opinions concerning the evaluation and ventilatory management of patients with SCD admitted to the ICU. This clinical practice survey was an observational study collecting medical opinions and practices. It was approved by the Ethics and Research Committee of the Paris-Saclay University. Clinicians were provided an information letter. We developed the questions with the CARMAS Research Group and focused on the early evaluation and management of patients with SCD in the ICU. We carried out this survey online and sent it to the medical teams of the 55 reference/ competence centres in France (and overseas departments), identified on the Orphanet database (https:// www. orpha. net). 3 The survey (available in Data S1) included questions relating to three typical clinical case scenarios. The first was a hyperalgesic VOC, without other symptoms. Because chest pain is seen as a sign of early ACS, 4 in the second case, we added chest pain to the first clinical situation. The third clinical case was an ACS with chest pain, dyspnoea and fever. We grouped centres according to their annual case volume (more or less than 10 SCD patients per year). Continuous variables are reported as mean ± SD or median (interquartile range [IQR]), and categorical variables as n (%). The statistical analysis protocol is available in Data S1.Thirty-four centres completed the survey, including 22 (64.7%) university hospitals, 11 (32.4%) general hospitals and 1 (2.9%) private hospital. The median [IQR] number of ICU beds in these centres was 24 [18][19][20][21][22][23][24][25][26][27][28]. Half the ICUs admitted less than 10 patients with SCD annually. We therefore grouped centres according to the annual number of

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Ketamine for Sickle Cell Vaso-Occlusive Crises

Cited by 12 publications

References 40 publications

Clinical Uses of Ketamine in Children: A Narrative Review

Clinical Uses of Ketamine in Children: A Narrative Review

Emerging Therapies for the Management of Pain and Vaso-Occlusive Crises in Patients With Sickle Cell Disease: A Systematic Review of Randomized Controlled Trials

Comprehensive assessment, pain and ventilatory management during acute complications of adult sickle cell disease: A clinical practice survey in French intensive care units

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