The Effects of Small-Dose Ketamine on Propofol Sedation: Respiration, Postoperative Mood, Perception, Cognition, and Pain

Mortero, Rosendo F.; Clark, Laura; Tolan, Merritt M.; Metz, Robert; Tsueda, Kentaro; Sheppard, Rachel A.

doi:10.1097/00000539-200106000-00022

Cited by 144 publications

(110 citation statements)

References 21 publications

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“…6,18 However, low dose ketamine has less frequent incidence of adverse events and can obviate respiratory depression produced by opioids and produce opioid sparing for postoperative analgesia. 10,19,20 This is consistent with the results of this study. It has been reported that fentanyl can activate N-methyl-Daspartate (NMDA) mediated pain processes, enhancing pain sensitivity, and that this effect is reversed by ketamine pretreatment.…”

Section: Statisticssupporting

confidence: 93%

“…In contrast, fentanyl anesthesia may produce postoperative hyperalgesia and attenuate the effectiveness of morphine to relieve pain in the postoperative period. 19 The non-opioid treatment in this study produced analgesia with stable blood pressure and heart rate during surgery and a rapid recovery. This is an advantage compared to fentanyl for gastric bypass surgery in patients that are at risk for respiratory depression.…”

Section: Statisticsmentioning

confidence: 81%

See 1 more Smart Citation

Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery

Feld

Laurito

Beckerman

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Several non-opioid drugs have been shown to provide analgesia during and after surgery. We compared sevoflurane anesthesia with fentanyl analgesia to sevoflurane and non-opioid drug treatment for gastric bypass surgery and recovery.M Me et th ho od ds s: : Thirty obese patients (body mass index > 50 kg·m -2 ) undergoing gastric bypass were randomized to receive sevoflurane anesthesia with either fentanyl or a non-opioid regimen including ketorolac, clonidine, lidocaine, ketamine, magnesium sulfate, and methylprednisolone. Morphine use by patient-controlled analgesia (PCA) pump and pain score measured by visual analogue scale were determined in the postanesthesia care unit (PACU) and for the first 16 hr after surgery. Sedation was evaluated in the PACU. Investigators assessing patient outcomes were blinded to the study group.R Re es su ul lt ts s: : Fentanyl treated patients were more sedated in the PACU compared to the non-opioid group. Non-opioid treated patients required 5.2 ± 2.6 mg·hr -1 morphine by PCA during their stay in the PACU while patients anesthetized with fentanyl used 7.8 ± 3.3 mg·hr -1 (P < 0.05). Fentanyl and non-opioid treated patients showed no difference in pain score one or 16 hr after surgery.C Co on nc cl lu us si io on n: : Our results show that non-opioid analgesia produced pain relief and less sedation during recovery from gastric bypass surgery compared to fentanyl. Objectif : On reconnaît à certains médicaments non-opioïdes des Résultats : La sédation, notée à la SDR, était plus importante chez les patients traités au fentanyl, comparés à ceux traités avec un médicament non-opioïde. Les patients traités aux non-opioïdes ont demandé 5,2 ± 2,6 mg·h -1 de morphine en AAC pendant leur séjour en SDR tandis que les patients anesthésiés au fentanyl en ont utilisé 7,8 ± 3,3 mg·h -1 (P < 0,05). Les scores de douleurs des patients des deux groupes n'ont présenté aucune différence, une ou 16 h après l'opération. Conclusion : L'analgésie avec des non opioïdes, comparé au fentanyl, a mieux soulagé la douleur et provoqué moins de sédation pendant la récupération qui suit un pontage gastrique.HE body mass index (BMI), calculated as the weight in kilograms divided by the height in metres squared, has been used in clinical and epidemiological studies as a predictor of health risk. 1 A BMI of 25 kg·m -2 is considered normal, > 30 kg·m -2 obese, > 35 kg·m -2 morbidly obese and > 55 kg·m -2 super morbidly obese. Respiratory problems are associated with morbid obesity, including obstructive apnea during sleep, decreased functional residual capacity and lung compliance and increased work of breathing. 2,3 Obese patients may be sensitive to the respiratory depressant effect of opioid analgesic drugs and more likely to require postoperative ventilation to avoid hypoxic episodes.

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Section: Statisticssupporting

confidence: 93%

Section: Statisticsmentioning

confidence: 81%

Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery

Feld

Laurito

Beckerman

et al. 2003

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

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“…Whereas some investigations have reported memory and cognitive impairment after subdissociative doses of ketamine [22], others have reported improved postoperative mood and function after perioperative administration of ketamine [23]. Furthermore, postoperative perceptual disturbances are common in the absence of ketamine [24].…”

Section: Discussionmentioning

confidence: 99%

Ketamine as an Adjunct to Postoperative Pain Management in Opioid Tolerant Patients after Spinal Fusions: A Prospective Randomized Trial

Urban

Deau

Wukovits

et al. 2008

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

101

100

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Management of acute postoperative pain is challenging, particularly in patients with preexisting narcotic dependency. Ketamine has been used at subanesthetic doses as a N-methyl D-aspartate (NMDA) receptor antagonist to block the processing of nociceptive input in chronic pain syndromes. This prospective randomized study was designed to assess the use of ketamine as an adjunct to acute pain management in narcotic tolerant patients after spinal fusions. Twenty-six patients for 1-2 level posterior lumbar fusions with segmental instrumentation were randomly assigned to receive ketamine or act as a control. Patients in the ketamine group received 0.2 mg/kg on induction of general anesthesia and then 2 mcg kgfor the next 24 hours. Patients were extubated in the operating room and within 15 minutes of arriving in the Post Anesthesia Care Unit (PACU) were started on intravenous patient-controlled analgesia (PCA) hydromorphone without a basal infusion. Patients were assessed for pain (numerical rating scale [NRS]), narcotic use, level of sedation, delirium, and physical therapy milestones until discharge. The ketamine group had significantly less pain during their first postoperative hour in the PACU (NRS 4.8 vs 8.7) and continued to have less pain during the first postoperative day at rest (3.6 vs 5.5) and with physical therapy (5.6 vs 8.0). Three patients in the control group failed PCA pain management and were converted to intravenous ketamine infusions when their pain scores improved. Patients in the ketamine group required less hydromorphone than the control group, but the differences were not significant. Subanesthetic doses of ketamine reduced postoperative pain in narcotic tolerant patients undergoing posterior spine fusions.

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“…The most commonly used intravenous agent for general anaesthesia or MAC is propofol. Although propofol provides dose-dependant sedation, amnesia and an anxiolytic effect, it requires an additional analgesic agent as it has no analgesic effect [6,7]. It is especially preferred in outpatient surgery, as it provides a short duration of recovery and early discharge from hospital.…”

mentioning

confidence: 99%

Comparison of ketamine-propofol and remifentanil in terms of hemodynamic variables and patient satisfaction during monitored anaesthesia care

Öncül

Gaygusuz²,

Yılmaz³

et al. 2016

Anaesthesiol Intensive Ther

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Background: This study aimed to compare remifentanil and ketamine-propofol in terms of hemodynamic response, duration of recovery and patient satisfaction in operative hysteroscopy cases who underwent monitored anaesthesia care in combination with paracervical block. Methods: Monitored anaesthesia care was used in 60 ASA I-II female patients. The patients were divided into two groups as remifentanil (Group R) and ketamine-propofol (Group K-P). The hemodynamic effects of remifentanil and ketamine-propofol, and duration of recovery were recorded and compared. The patient satisfaction was also recorded and the two groups were compared. Results: Age, body mass, ASA status, duration of anaesthesia and type of surgery were found to be similar between groups. The time of the Aldrete score reaching ≥ 9 was found to be shorter in Group R when compared with Group KP (Group R: 4.1 ± 1.9 min, Group K-P: 6.1 ± 2.6 min) (P < 0.05). The incidence of postoperative nausea and vomiting was found to be significantly higher in the remifentanil group (P ≤ 0.05). When the groups were compared in terms of patient satisfaction, in both groups this was found to be similar. Conclusion: Sedation with remifentanil combined with a paracervical block during monitored anaesthesia care provides early recovery with effective sedation and analgesia in hysteroscopy procedures.

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The Effects of Small-Dose Ketamine on Propofol Sedation: Respiration, Postoperative Mood, Perception, Cognition, and Pain

Cited by 144 publications

References 21 publications

Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery

Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery

Ketamine as an Adjunct to Postoperative Pain Management in Opioid Tolerant Patients after Spinal Fusions: A Prospective Randomized Trial

Comparison of ketamine-propofol and remifentanil in terms of hemodynamic variables and patient satisfaction during monitored anaesthesia care

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