The effect of ketamine on hypoventilation during deep sedation with midazolam and propofol

Oliveira, Gildàsio S. De; Fitzgerald, Paul C.; Hansen, Nora M.; Ahmad, Shireen; McCarthy, Robert J.

doi:10.1097/eja.0000000000000025

Cited by 25 publications

(15 citation statements)

References 41 publications

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“…Studies demonstrated that ketamine, when combined with other sedative medications, mostly propofol, may decrease respiratory-related adverse effects. 194 , 195 One such prospective observational study looking at sedation-related risk factors (airway obstruction, hypoventilation, and desaturation) for procedural sedation found ketamine to be a protective factor. 195 De Oliveira et al 194 reported that ketamine decreased duration and severity of hypercapnia in patients undergoing breast surgery under deep sedation.…”

Section: Intraoperative Medication Use In Patients With Osamentioning

confidence: 99%

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Memtsoudis

Cozowicz

Nagappa

et al. 2018

Anesthesia &Amp; Analgesia

146

158

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The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.

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Section: Intraoperative Medication Use In Patients With Osamentioning

confidence: 99%

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Memtsoudis

Cozowicz

Nagappa

et al. 2018

Anesthesia &Amp; Analgesia

146

158

View full text Add to dashboard Cite

show abstract

“…It is important to realise that we and others observed a ketamine-induced stimulatory effects on breathing at subanaesthetic ketamine doses. 13,15 In rats, Eikermann and colleagues 14 showed that respiratory stimulation persists even at anaesthetic doses, while Hamza and colleagues 35 found the reverse in children. Further human studies are needed to fully understand the complex behaviour of the low-and high-dose ketamine isomers on breathing.…”

Section: Esketamine-and Racemic Ketamine-induced Stimulation Vs Deprementioning

confidence: 99%

Esketamine counters opioid-induced respiratory depression

Jonkman

Rijnsoever

Olofsen

et al. 2018

British Journal of Anaesthesia

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“…In a study of 54 women undergoing breast surgery, severe hypoventilation was found to be significantly lower (0% vs 28%) in patients who received ketamine in addition to propofol and midazolam for procedural sedation. 10 This evidence may suggest that, in our patient, the beneficial effects observed may be due to ketamine administration enhancing the effects of opioids. However, it is difficult to apply data from noncritically ill women undergoing elective surgery to our patient, as ketamine may have varying effects based upon numerous factors including gender, critical illness, and use of concurrent medications.…”

Section: Discussionmentioning

confidence: 62%

Successful Use of Ketamine for Central Neurogenic Hyperventilation: A Case Report

Jones

Wiss

Goyal

et al. 2017

The Neurohospitalist

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This report describes the use of ketamine in a patient with central neurogenic hyperventilation following intracerebral hemorrhage. A 41-year-old man was admitted with right thalamic intracerebral hemorrhage with intraventricular extension requiring emergent external ventricular drain placement. After aggressive management of his neurologic status and other associated complications, the patient subacutely developed an altered respiratory pattern characterized by shallow, rapid breaths. After the use of multiple sedative agents to control respiratory drive had failed, a single 2 mg/kg bolus dose of intravenous ketamine was administered. In the 6 hours prior to ketamine dosing, respiratory rate ranged from 24 to 40 breaths per minute. Within minutes of ketamine administration, respiratory patterns improved and primarily ranged from 16 to 20. Twenty-four hours after ketamine administration, the patient was successfully extubated following 12 days of mechanical ventilation. Further research is needed to determine the widespread applicability of this strategy.

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The effect of ketamine on hypoventilation during deep sedation with midazolam and propofol

Abstract: clinicaltrials.gov identifier: NCT01535976.

Cited by 25 publications

References 41 publications

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea

Esketamine counters opioid-induced respiratory depression

Successful Use of Ketamine for Central Neurogenic Hyperventilation: A Case Report

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