Ketamine Infusion for Postoperative Analgesia in Asthmatics

Abstract

Narcotics commonly used for postoperative analgesia may release histamine and cause bronchospasm in asthmatics. Ketamine, on the other hand, provides analgesia and has the additional advantage of preventing and relieving bronchospasm. We therefore delivered subanesthetic doses of ketamine in combination with midazolam (5.88-6.42 micrograms.kg-1.min-1 and 1.17-1.28 micrograms.kg-1.min-1, respectively), via an infusion for postoperative analgesia after elective abdominal hysterectomy in patients with asthma. Data were compared with those from a similar group of patients receiving conventional intramuscular meperidine. A significant degree and earlier onset of analgesia (P < 0.05) was achieved in the ketamine group. For other variables no significant difference was observed between the groups (P > 0.05). Ketamine-midazolam infusion can thus provide a safe alternative to the usual parenteral narcotic therapy in asthmatics, in terms of analgesia and patient acceptability.

Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes

“…ketamine have heterogeneous designs (Table 3). Ketamine has been administered as either a single bolus injection (Maurset et al, 1989;Ngan Kee et al, 1997), bolus injection followed by a continuous infusion (Joachimsson et al, 1986;Owen et al, 1987;Jahangir et al, 1993), continuous infusion (Clausen et al, 1975), continuous infusion combined with either an opioid or a benzodiazepine (Edwards et al, 1993;Jahangir et a1., 1993;Stubhaug et a1., 1997;Wilder-Smith et al, 1998), or via a patient-controlled device (PCA) (Javery et al, 1996).…”

“…Ketamine produces effective but short acting pain relief when administered as a single bolus of > 300 pg/kg (Maurset et al, 1989). Ketamine does not have any effect on postoperative pain or morphine consumption when administered (without a loading dose) as a continuous infusion of less than 4 p,gkg per min (Edwards et aI.,1993).In combination with a loading dose however, ketamine infusion rates of 1-6 pg/kg per min provide evidence ofanti-hyperalgesic, analgesic and opioid sparing effects (Owen et al, 1987;Jahangir et al, 1993;Stubhaug et al, 1997). At higher doses, ketamine appears to provide an equivalent degree of postoperative pain relief as do opioids, but onset can be Author and year…”

“…The rationale for preemptive analgesia in the management of postoperative pain has been reviewed in detail (Katz et al, 1992;Coderre et al, 1993;Dahl and Kehlet, 1993;Woolf and Chong, 7993;Katz,1995 (Maduska and Hajghassemali, 1978;White et al, 1982;Bourke et aL, 1987;Owen et al, 1981;Peat et al, 1989;Edwards et aI., 1993;Jahangir et al, 1993;Bhattacharya et a1.,1994 Jahangir et al, 1993 ;Bhattacharya et al, 199 4). Two studies (Joachimsson et al, 1986;Roytblat et a1.,1993) found a decrease in heart rate and blood pressure which was attributed to a decrease in pain.…”

“…Other adverse effects such as a sense ofintoxication, dizziness, blurred vision, itching or nausea and vomiting occur more commonly but the incidence of these adverse effects does not appear to differ from that of opioids (Sethna et al, 1998). At higher doses and plasma levels (200 ng/ml), incidence of cognitive and memory impairments, psychiatric symptoms, illusory experiences and other adverse effects increases (Krystal et al, 1994(Krystal et al, ', 1998Adler et al, 1998;Bowdle et al, 1998;Sethna et a1., 1998 (Joachimsson et al, 1986;Maurset et al, 1989) or as a 'feeling of unreality' (Ito and Ichiyanagi, 1974) might provide an alternative to conventional opioid analgesia (Jahangir et al, 1993).…”

CARDIAC ARREST IN A POSTOPERATIVE CARE UNIT. LITERATURE REVIEW OF PULMONARY PERIOPERATIVE CRITICAL SITUATIONS - Paro cardiaco en unidad de cuidado postoperatorio. Revisión de la literaturade situaciones críticas pulmonares preoperatorias.

“…Los anestésicos volátiles todavía se recomiendan para las técnicas de anestesia general. El propofol se considera es el agente de elección para la inducción de la anestesia en los asmáticos (39) , y la ketamina también tiene propiedades broncodilatadoras (40) . El uso de la anestesia regional no reduce las complicaciones postoperatorias pulmonares en asmáticos asintomáticos, mientras que es ventajoso en pacientes sintomáticos (41) .…”