Low-dose ketamine with clonidine and midazolam for adult day care surgery

Dalsasso, M.; Tresin, P.; Innocente, Francesco; Veronese, S.; Öri, C.

doi:10.1017/s0265021505210141

Cited by 5 publications

(8 citation statements)

References 32 publications

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“…The remaining studies used the ISAS to assess satisfaction with Monitored Anesthetic Care for other procedures and surgery. [33][34][35][36][37][38][39][40] Pediatrics (table 5) We identified six tools used in pediatric anesthesia, which had undergone psychometric development. [41][42][43][44][45][46] Kain et al 44 developed an 11-item questionnaire using a three-step approach starting with validity testing in the form of items grouping using input from anesthetists, surgeons, psychologists, play specialists, and nurses.…”

Section: Monitored Anesthetic Care (Table 4)mentioning

confidence: 99%

Patient-Satisfaction Measures in Anesthesia

et al. 2013

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Patient satisfaction is an important measure of the quality of health care and is used as an outcome measure in interventional and quality improvement studies. Previous studies have found that there are few appropriately developed and validated questionnaires available. The authors conducted a systematic review to identify all tools used to measure patient satisfaction with anesthesia, which have undergone a psychometric development and validation process, appraised the quality of these processes, and made recommendations of tools that may be suitable for use in different clinical and academic settings. There are a number of robustly developed and subsequently validated instruments, however, there are still many studies using nonvalidated instruments or poorly developed tools, claiming to accurately assess satisfaction with anesthesia. This can lead to biased and inaccurate results. Researchers in this field should be encouraged to use available validated tools, to ensure that patient satisfaction is measured and reported fairly and accurately.

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Section: Monitored Anesthetic Care (Table 4)mentioning

confidence: 99%

Patient-Satisfaction Measures in Anesthesia

et al. 2013

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“…Obesity is associated with higher rates of chronic pain and higher scores of post-operative pain, which are both challenging to treat in this patient population (Belcaid and Eipe, 2019;Mills et al, 2019). As opioids may induce ventilatory impairment, multimodal opioid-and muscle relaxant-sparing techniques are being investigated to improve the safety of analgesia in obese patients; in this regard, KET may present specific advantages (Ori et al, 2003;Dalsasso et al, 2005;Freo et al, 2011;Carron et al, 2012;García-Henares et al, 2018;Aronsohn et al, 2019).…”

Section: Effects Of Ket On Post-operative Painmentioning

confidence: 99%

Neuromodulatory Interventions for Pain

2022

Frontiers Research Topics

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“…Obesity is associated with higher rates of chronic pain and higher scores of post-operative pain, which are both challenging to treat in this patient population ( Belcaid and Eipe, 2019 ; Mills et al, 2019 ). As opioids may induce ventilatory impairment, multimodal opioid- and muscle relaxant-sparing techniques are being investigated to improve the safety of analgesia in obese patients; in this regard, KET may present specific advantages ( Ori et al, 2003 ; Dalsasso et al, 2005 ; Freo et al, 2011 ; Carron et al, 2012 ; García-Henares et al, 2018 ; Aronsohn et al, 2019 ).…”

Section: Clinical Studiesmentioning

confidence: 99%

“…The effects of KET as the main anesthetic agent were determined in 500 patients (172 males and 328 females, ASA I–II, age 53.9 ± 12.2 years, weight 76.1 ± 22.5 kg) undergoing an opioid-free anesthesia for day surgery including breast surgery, laparoscopy, superficial excision of minor lesions, thoracoscopy, appendectomy, and proctology ( Dalsasso et al, 2005 ). At induction, patients received IV midazolam 0.03–0.05 mg/kg, clonidine 150 μg, and KET 0.4 mg/kg; the latter was repeated as needed during surgery (mean total dose 0.6 ± 0.2 mg/kg).…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Anesthesia was maintained with nitrous oxide and sevoflurane. Seventy-four percent of patients were eligible to discharge from the operating theater by 30 min, and all patients were dischargeable by 1 h. Patients did not complain of hallucinations, while presenting a high rate of satisfaction at the Iowa Satisfaction with Anesthesia Scale ( Dalsasso et al, 2005 ).…”

Section: Clinical Studiesmentioning

confidence: 99%

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Analgesic and Antidepressant Effects of the Clinical Glutamate Modulators Acetyl-L-Carnitine and Ketamine

et al. 2021

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Pain and depression are leading causes of disability and of profound social and economic burden. Their impact is aggravated by their chronicity and comorbidity and the insufficient efficacy of current treatments. Morphological and functional metabolism studies link chronic pain and depressive disorders to dysfunctional neuroplastic changes in fronto-limbic brain regions that control emotional responses to painful injuries and stressful events. Glutamate modulators are emerging new therapies targeting dysfunctional brain areas implicated in the generation and maintenance of chronic pain and depression. Here, we report the effects of two clinically approved glutamate modulators: acetyl-L-carnitine (ALCAR) and S, R(±)ketamine (KET). ALCAR is a natural neurotrophic compound currently marketed for the treatment of neuropathies. KET is the prototypical non-competitive antagonist at N-methyl-D-aspartate glutamate receptors and a clinically approved anesthetic. Although they differ in pharmacological profiles, ALCAR and KET both modulate aminergic and glutamatergic neurotransmissions and pain and mood. We assessed in rats the effects of ALCAR and KET on cerebral metabolic rates for glucose (rCMRglc) and assessed clinically the effects of ALCAR in chronic pain and of KET in post-operative pain. ALCAR and KET increased rCMRglc at similar degrees in prefrontal, somatosensory, and cingulate cortices, and KET increased rCMRglc at a different, much larger, degree in limbic and dopaminergic areas. While rCMRglc increases in prefrontal cortical areas have been associated with analgesic and antidepressant effects of ALCAR and KET, the marked metabolic increases KET induces in limbic and dopaminergic areas have been related to its psychotomimetic and abuse properties. In patients with chronic neuropathic pain, ALCAR (1,000 mg/day) yielded to a fast (2 weeks) improvement of mood and then of pain and quality of life. In day-surgery patients, KET improved dischargeability and satisfaction. In obese patients undergoing bariatric surgery, a single, low dose of KET (0.5 mg/kg) at induction of anesthesia determined a very fast (hours) amelioration of post-operative depression and pain and an opioid-sparing effect. These findings indicate that ALCAR and KET, two non-selective glutamate modulators, still offer viable therapeutic options in comorbid pain and depression.

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Low-dose ketamine with clonidine and midazolam for adult day care surgery

Cited by 5 publications

References 32 publications

Patient-Satisfaction Measures in Anesthesia

Patient-Satisfaction Measures in Anesthesia

Neuromodulatory Interventions for Pain

Analgesic and Antidepressant Effects of the Clinical Glutamate Modulators Acetyl-L-Carnitine and Ketamine

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