S(+)‐ketamine in paediatric anaesthesia

Effects of preoperative epidural administration of racemic ketamine for analgesia in sheep undergoing surgery

“…24,[57][58][59] Thus, consistent with the concept of multimodal preemptive analgesia, 60 it is possible that the findings obtained during the first 6 hours of postoperative evaluation of the sheep in our study may have been a consequence of concomitant inflammatory modulation and inhibition of NMDA-receptor activation. 60 Multimodal epidural analgesia provided by the combination of ketamine and local anesthetics, opioids, or α 2 -adrenoreceptor agonists has been investigated in several studies 4,7,11,29,31,32,37,40,41,44,47,[61][62][63] in laboratory animals and humans undergoing thoracic surgery or surgery of the upper or lower portions of the abdomen. Many studies 29,32,41,47,62,63 revealed that the addition of ketamine resulted in significantly longer periods of analgesia and reduced the need for complementary analgesics.…”

“…60 Multimodal epidural analgesia provided by the combination of ketamine and local anesthetics, opioids, or α 2 -adrenoreceptor agonists has been investigated in several studies 4,7,11,29,31,32,37,40,41,44,47,[61][62][63] in laboratory animals and humans undergoing thoracic surgery or surgery of the upper or lower portions of the abdomen. Many studies 29,32,41,47,62,63 revealed that the addition of ketamine resulted in significantly longer periods of analgesia and reduced the need for complementary analgesics. A synergistic effect of epidural ketamine combined with 0.5% bupivacaine was not detected in 1 investigation in humans, 61 possibly because the high concentration of bupivacaine masked any interaction of the 2 drugs; however, a synergistic effect of the 2 agents has been identified in studies 29,31,40,44,63 involving lower concentrations of bupivacaine.…”

Management of postoperative pain in children

“…Although preservative-free racemic ketamine is a very effective agent, preservative-free S(+)ketamine is more potent and may reduce neuropsychiatric effects. 20 The main action of adjunct ketamine is via spinal Nmethyl-D-aspartate (NMDA) receptors, as the same dose given systemically produces a much shorter duration of analgesia. Neuraxial administration of opioids still has a place where extensive analgesia is needed, for example after spinal surgery or liver transplantation or when adequate spread of local anaesthetic blockade cannot be achieved within dosage limits.…”

Cetamina e analgesia preemptiva

“…Parece não haver diferença entre o uso isolado de cetamina racêmica e sua associação a midazolam em relação ao tempo de recuperação pós-anestésica de crianças submetidas à anestesia geral com sevoflurano 51 . O uso de S(+) cetamina por via retal como medicação pré-anestésica de crianças foi menos efetivo e produziu maior incidência de efeitos colaterais que com midazolam 52 . Tanto em adultos como em crianças, a cetamina foi associada à anestesia regional, sendo que a dose de 0,5 mg.kg -1 de cetamina com 0,15 mg.kg -1 de diazepam por via venosa não produziu tantos efeitos colaterais 53 .…”

“…It seems to be no difference between racemic ketamine alone or associated with midazolam in post-anesthetic recovery time of children submitted to general anesthesia with sevoflurane 51 . Rectal S(+) ketamine as preanesthetic medication in children has been less effective and has promoted higher incidence of side effects as compared to midazolam 52 . Ketamine has been associated to regional anesthesia both in adults and children and intravenous 0.5 mg.kg -1 ketamine with 0.15 mg.kg -1 diazepam has not produced so many side effects 53 .…”