Pharmacology of Ketamine Isomers in Surgical Patients

White, Paul F.; Ham, Jay; Way, Walter L.; Trevor, Anthony J.

doi:10.1097/00000542-198003000-00008

Cited by 387 publications

(164 citation statements)

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“…More psychic emergence reactions occurred after (-)ketamine than the racemate or (+)ketamine. 84 In a more recent study, White et al found that (+)ketamine was approximately four times as potent as (-)ketamine. (+)Ketamine and the racemate produced similar EEG changes, but (-)ketamine produced a lesser degree of EEG slowing.…”

Section: Optical Isomersmentioning

confidence: 99%

Ketamine: an update on the first twenty-five years of clinical experience

1989

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Section: Optical Isomersmentioning

confidence: 99%

Ketamine: an update on the first twenty-five years of clinical experience

1989

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“…It is available as a racemic mixture that contains equal amounts of the two isomers S(*)-ketamine and R(-)-ketamine. In both animals and humans S(*)-ketamine is 3-4 times more potent than R(-)-ketamine for pain relief (Marietta et al, 1977;Ryder et al, 1978; White et al, 1985;Oye et al, 1992;Mathisen et al, 1995;) and in equianalgesic doses, produces fewer psychic disturbances and less agitation than R(-)-ketamine or the racemate (Marietta et aL., 1977;Ryder et al,1978;White et al, 1980;Calvey, 1995) but see (Schuttler,1992;Mathisen et al, 1995).…”

Section: Pharmacologymentioning

confidence: 99%

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

Schmid

Sandler

Katz

1999

Pain

492

268

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“…During the recovery period, there was a reestablishment in the haemodynamic parameters due to lower concentrations of drugs in the central nervous system. Some studies in humans have shown that patients treated with equianaesthetic doses of S(+) ketamine felt less fear, disorientation and pain in postoperative period, and described more wellness and happiness when compared with racemic ketamine (White et al 1980). These results may explain the faster recovery rate in the PSK group.…”

Section: Discussionmentioning

confidence: 97%

“…According to some authors, propofol promotes decrease in cardiac output (Maneglia & Cousin 1988, Goodchild & Serrao 1989 and increase in heart rate to compensate the decrease in arterial blood pressure (Hall & Chambers 1987, Claeys et al 1988. On the other hand, anaesthesia with ketamine produces an excessive sympathomimetic action with increases the heart rate and arterial blood pressure (White et al 1980), as well as a dose-related increase in the rate-pressure product with a transient increase in the cardiac index but no alteration in the stroke index (Tweed et al 1972, Idvall et al 1979. After administration of racemic or S(+) ketamine in equianalgesic doses, identical and significant increases in plasma cathecolamines, arterial blood pressure and heart rate are observed (Adams et al 1992, Adams 1997.…”

Section: Discussionmentioning

confidence: 99%

Total intravenous anaesthesia with propofol-racemic ketamine and propofol-S-ketamine: a comparative study and haemodynamic evaluation in dogs undergoing ovariohysterectomy

et al. 2008

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216Pesq. Vet. Bras. 28(4):216-222, abril 2008 RESUMO.-[Anestesia total intravenosa com propofolquetamina racêmica e propofol quetamina-S: estudo comparativo e avaliação hemodinâmica em cães submetidos à ovariohisterectomia.] A anestesia total intravenosa (TIVA) com propofol e quetamina proporciona um efeito muito satisfatório do ponto de vista clínico. Este estudo, cego e randomizado, comparou a indução e manutenção da anestesia com infusão contínua de propofolquetamina racêmica (PRK) e propofol-quetamina-S (PSK) em cães, e avaliou seus efeitos hemodinâmicos, metabó-licos e ventilatórios. Foram avaliadas sete cadelas em cada grupo, submetidas à ovariohisterectomia. A anestesia foi induzida no Grupo PRK, com propofol (4.0mg kg -1 ) e cetamina (2.0mg kg -1 ) por via intravenosa (i.v.), seguida de infusão contínua de propofol (dose inicial de 0.5mg kg -1 min -1 ) e cetamina racêmica(0.2mg kg -1 min -1 ) i.v. No Grupo PSK, a indução anestésica foi com propofol (4.0mg kg -1 ) e cetamina-S (1.0 mg kg -1 ) i.v., seguida de infusão contínua de propofol (dose inicial de 0,5mg kg -1 min -1 ) e Total intravenous anaesthesia (TIVA) with propofol and ketamine proved to be very satisfactory from a clinical point of view. This blind randomised controlled trial was designed to compare induction and maintenance of anaesthesia under continuous infusion of propofol-racemic ketamine (PRK) with that of propofol-S-ketamine (PSK) and evaluate their haemodynamic, metabolic and ventilatory effects. Seven female dogs undergoing ovariohysterectomy were involved in each group. Anaesthesia was induced: in Group PRK, with propofol (4.0mg kg -1 ) and racemic ketamine (2.0mg kg -1 ) intravenous (i.v.), followed by i.v. infusion of propofol (initial dose of 0.5mg kg -1 min -1 ) and racemic ketamine (0.2mg kg -1 min -1 ); in Group PSK, with propofol (4.0mg kg -1 ) and S-ketamine (1.0 mg kg 1 ) i.v., followed by i.v. infusion of propofol (initial dose of 0.5mg kg -1 min -1 ) and S-ketamine (0.1mg kg -1 min -1 ). Parameters were assessed before anaesthesia and in 6 time points after induction. In both groups, heart rate increased significantly at all time points. There was a slight decrease in systemic blood pressure, cardiac output and cardiac index in both groups. The systolic index decrease significantly and intense respiratory depression was observed in all groups, making assisted ventilation necessary. Total intravenous anaesthesia with propofol-racemic ketamine and propofol-S-ketamine 217 cetamina-S ( 0.1mg kg -1 min -1 ) i.v. Os parâmetros foram observados antes da anestesia e em seis momentos após a indução anestésica. Em ambos os grupos, a freqüência cardíaca elevouse significantemente em todos os momentos. Houve pequena redução na pressão arterial sistêmica, débito cardíaco e índice cardíaco. O índice sistólico apresentou redução significante e houve intensa depressão respirató-ria em ambos os grupos. A anestesia total intravenosa com a associação do propofol à cetamina racêmica ou à cetamina-S proporciona boa estabilidade hemodinâmic...

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Pharmacology of Ketamine Isomers in Surgical Patients

Cited by 387 publications

References 0 publications

Ketamine: an update on the first twenty-five years of clinical experience

Ketamine: an update on the first twenty-five years of clinical experience

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

Total intravenous anaesthesia with propofol-racemic ketamine and propofol-S-ketamine: a comparative study and haemodynamic evaluation in dogs undergoing ovariohysterectomy

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