Untersuchungen zur Wirkung von Ketamin im experimentellen hämorrhagischen Schock

Brückner, J. B.; Patschke, D.; Reinecke, Alexander; Tarnow, J.

doi:10.1007/978-3-642-65498-5_12

Cited by 4 publications

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“…However, for maintenance, ketamine may be a liability in patients with severe coronary insufficiency since myocardial oxygen consumption has been shown to be elevated by ketamine (10). In addition, dogs made hypotensive by bleeding develop a greater oxygen debt and deteriorate earlier with ketamine than with halothane or neuroleptanalgesia (17). After bron chopulmonary lavage in man, one of us (CFL) has noted a greater base-deficit with ketamine-relaxant anesthesia than with halothane-relaxant anesthesia despite com parable acid-base status during lavage.…”

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Ketamine Anesthesia

Lanning¹,

Harmel²

1975

Annu. Rev. Med.

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Ketamine [2-(o-chlorophenyl)-2-methylamino cyclohexanone HCl], a unique gen eral anesthetic whose lack of cardiorespiratory depression is unequalled by any other general anesthetic currently available, was introduced in 1965 by McCarthy et al (1) and Domino, Chodoff & Corssen (2). It is an extremely versatile agent because it may be administered intravenously (Lv.) or intramuscularly (i.m.) without signifi cant tissue irritation. As yet, contraindications to its use with other drugs used in anesthesia have not been demonstrated. Ketamine provides a profound analgesia characterized by a trance-like, cataleptic state with generalized mild hypertonus, nystagmus, cardiovascular stimulation, lack of respiratory depression, and laryngeal and pharyngeal competence. Onset of action is rapid, being 20-30 sec for Lv. and 3-5 min for i.m administration. Duration of surgical anesthesia is 5-10 min and 15-25 min following i.v. and i.m. doses. The usual range of ketamine dosage is 1-2 mg/kg i. v. and 5-10 mg/kg i.m. Maintenance doses are usually one half the induc tion dose. Its use for outpatient procedures has progressively decreased because time-to-ambulation may be prolonged, frequently lasting more than 2 hr. Wessels, Allen & Slogoff (3) have demonstrated that NP enhances ketamine by reducing the total dose of ketamine 39% and shortening the recovery period by 64%. Initially, ketamine did not appear to provide visceral analgesia; but, its use with NP and relaxants provides adequate anesthesia for intraabdominal and thoracic surgery (4). For these reasons, ketamine is now more commonly used in combination with other anesthetic agents rather than as a monoanesthetic.Ketamine is rapidly distributed into all body tissues, primarily into fat, liver, lung, and brain. Metabolism occurs in the liver by N-demethylation and hydroxylation of the cyclohexanone ring with formation of water-soluble conjugates which are excreted in the urine. Human studies demonstrate an apparent biological half-life of 4 hr. with 70% urinary excretion in 24 hr. as the metabolized derivatives (5). However, Latarjet et al (6) have shown that ketamine's duration is not prolonged in humans with renal insufficiency. Ketamine has proved to have a broad therapeutic index. McCarthy et al (1) demonstrated in dogs a ketamine LDsoiEDso ratio five times that of pentobarbital. Repeated administrations have been given to humans without developing any sig-137 Annu. Rev. Med. 1975.26:137-141. Downloaded from www.annualreviews.org Access provided by Syddansk University on 02/03/15. For personal use only. Quick links to online content Further ANNUAL REVIEWS

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