La ketamina (compuesto CI-581) es un derivado la fenciclidina, formulado como mezcla racémica donde los dos estereoisómeros tienen diferente potencia anestésica-analgésica, pero cinética similar. Es una droga fantástica que fue introducida en anestesia por Corssen en 1966. Posee efectos anestésicos, sedantes, amnésicos, neuroprotectivos, analgésicos y recreacionales. Este fármaco ha sido redescubierto en forma reciente cuando se conocieron sus interacciones con el receptor NMDA y ahora se utiliza por diversas vías (iv, im, oral, bucal, rectal, neuroaxial, nasal), no solo en anestesia, sino en dolor agudo y en dolor crónico oncológico y no oncológico
Ketamine (compound CI-581) is a phencyclidine derivative, formulated as a racemic mixture where the two stereoisomers have different anesthetic-analgesic potency, but similar kinetics. It's a great drug that was introduced in 1966 by Corssen in clinical anesthesia. It has anesthetic, sedative, amnesic, neuroprotective, analgesic and recreational effects. This drug has been rediscovered recently due to its interactions with the NMDA receptor and is now used by various routes (iv, im, oral, buccal, rectal, neuraxial, nasal), not only in anesthesia, but also in post operative pain, chronic cancer pain and noncancer chronic pain.
Ketamina perioperatoria con infusión ambulatoria con bomba infusión como coadyuvante en el tratamiento del dolor agudo postoperatorio por fusión espinal en adultos: estudio prospectivo aleatorizado
Peri-operative ketamine with the ambulatory elastometric infusion pump as an adjuvant to manage acute postoperative pain after spinal fusion in adults: a prospective randomized trial.
Yeom JH, Chon MS, Jeon WJ, Shim JH.
Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea.
Korean J Anesthesiol. 2012 Jul;63(1):54-8. Epub 2012 Jul 24.
Abstract
BACKGROUND: In this study, we assessed the effectiveness of ketamine as an alternative to non-steroidal anti-inflammatory drugs (NSAID), to manage acute postoperative pain after spinal fusion when given intravenously via a patient-controlled analgesia (PCA) pump in which the dose was proportional to that of fentanyl. METHODS: Forty patients undergoing 1-2 level spinal fusion were enrolled in this study. Patients were intraoperatively randomized into two groups to receive intravenous PCA consisting either of fentanyl 0.4 µg/ml/kg (control group) or fentanyl 0.4 µg/ml/kg with ketamine 30 µg/ml/kg (ketamine group) after intravenous injection of a loading dose. The loading dose in the control group was fentanyl 1 µg/kg with normal saline equal to ketamine volume and in the ketamine group it was fentanyl 1 µg/kg with ketamine 0.2 mg/kg. The verbal numerical rating scale (NRS), fentanyl and ketamine infusion rate, and side effects were evaluated at 1, 24, and 48 hours after surgery. RESULTS: There were no significant differences in patient demographics, duration of surgery and anesthesia or intra-operative opioids administration. We did not find any significant differences in the mean infusion rate of intraoperative remifentanil or postoperative fentanyl or in the side effects between the groups, but we did find a significant difference in the NRS between the groups. CONCLUSIONS: Based on our results, we conclude that a small dose of ketamine (0.5-2.5 µg/kg/min) proportional to fentanyl is not only safe, but also lowers postoperative pain intensity in patients undergoing spinal fusion, although the opioid-sparing effects of ketamine were not demonstrated.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408516/?tool=pubmed
Comparación del efecto preventivo de la ketamina rectal y del acetaminofen rectal después de amigdalectomía en niños
Comparison of the Preventive Analgesic Effect of Rectal Ketamine and Rectal Acetaminophen after Pediatric Tonsillectomy.
Heidari SM, Mirlohi SZ, Hashemi SJ.
Department of Anesthesiology and Intensive Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Prev Med. 2012 Mar;3(Suppl1):S150-S155.
Abstract
OBJECTIVES: There is a little data about rectal administration of Ketamine as a postoperative analgesic, so we compared the efficacy of rectal ketamine with rectal acetaminophen, which is applied routinely for analgesia after painful surgeries like tonsillectomy.METHODS: In this single-blinded comparative trial, we enrolled 70 children undergoing elective tonsillectomy, and divided them randomly in two groups. Patients received rectal ketamine (2 mg / kg) or rectal acetaminophen (20 mg / kg) at the end of surgery. The children's Hospital of Eastern Ontario Pain scale was used to estimate pain in children. Also the vital signs, Wilson sedation scale, and side effects in each group were noted and compared for 24 hours. RESULTS: The ketamine group had a lower pain score at 15 minutes and 60 minutes after surgery in Recovery (6.4 ± 0.8, 7.4 ± 1 vs. 7.1 ± 1.2, 7.8 ± 1.2 in the acetaminophen group, P < 0.05) and one hour and two hours in the ward (7.2 ± 0.7, 7 ± 0.5 vs. 7.9 ± 1.2, 7.5 ± 1.2 in the acetaminophen group, P < 0.05), with no significant differences till 24 hours. Dreams and hallucinations were not reported in the ketamine group. Systolic blood pressure was seen to be higher in the ketamine group (104.4 ± 7.9 vs. 99.8 ± 7.7 in the acetaminophen group) and nystagmus was reported only in the ketamine group (14.2%). Other side effects were equivalent in both the groups. CONCLUSIONS: With low complications, rectal ketamine has analgesic effects, especially in the first hours after surgery in comparison with acetaminophen, and it can be an alternative analgesic with easy administration in children after tonsillectomy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399302/?tool=pubmed
Comparación de los efectos de la infiltración peritonsilar de ketamina y tramadol sobre el dolor post amigadalectomía: estudio doble ciego, randomizado, controlado y placebo
Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial.
Ayatollahi V, Behdad S, Hatami M, Moshtaghiun H, Baghianimoghadam B.
Department of Anesthesiology, Shahid Sadoughi Hospital, Bou ali BLVD, 8916886938 Yazd, Iran.
Croat Med J. 2012 Apr;53(2):155-61.
Abstract
AIM: To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. METHODS: The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. RESULTS: Tramadol group had significantly lower pain scores (P=0.005), significantly longer time to the first request for analgesic (P=0.001), significantly shorter time to the beginning of liquid regimen (P=0.001), and lower hemodynamic parameters such as blood pressure (P=0.001) and heart rate (P=0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. CONCLUSION: Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects.
http://neuron.mefst.hr/docs/CMJ/issues/2012/53/2/cmj_53_2_ayatollahi_22522994.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Ketamine (compound CI-581) is a phencyclidine derivative, formulated as a racemic mixture where the two stereoisomers have different anesthetic-analgesic potency, but similar kinetics. It's a great drug that was introduced in 1966 by Corssen in clinical anesthesia. It has anesthetic, sedative, amnesic, neuroprotective, analgesic and recreational effects. This drug has been rediscovered recently due to its interactions with the NMDA receptor and is now used by various routes (iv, im, oral, buccal, rectal, neuraxial, nasal), not only in anesthesia, but also in post operative pain, chronic cancer pain and noncancer chronic pain.
Ketamina perioperatoria con infusión ambulatoria con bomba infusión como coadyuvante en el tratamiento del dolor agudo postoperatorio por fusión espinal en adultos: estudio prospectivo aleatorizado
Peri-operative ketamine with the ambulatory elastometric infusion pump as an adjuvant to manage acute postoperative pain after spinal fusion in adults: a prospective randomized trial.
Yeom JH, Chon MS, Jeon WJ, Shim JH.
Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea.
Korean J Anesthesiol. 2012 Jul;63(1):54-8. Epub 2012 Jul 24.
Abstract
BACKGROUND: In this study, we assessed the effectiveness of ketamine as an alternative to non-steroidal anti-inflammatory drugs (NSAID), to manage acute postoperative pain after spinal fusion when given intravenously via a patient-controlled analgesia (PCA) pump in which the dose was proportional to that of fentanyl. METHODS: Forty patients undergoing 1-2 level spinal fusion were enrolled in this study. Patients were intraoperatively randomized into two groups to receive intravenous PCA consisting either of fentanyl 0.4 µg/ml/kg (control group) or fentanyl 0.4 µg/ml/kg with ketamine 30 µg/ml/kg (ketamine group) after intravenous injection of a loading dose. The loading dose in the control group was fentanyl 1 µg/kg with normal saline equal to ketamine volume and in the ketamine group it was fentanyl 1 µg/kg with ketamine 0.2 mg/kg. The verbal numerical rating scale (NRS), fentanyl and ketamine infusion rate, and side effects were evaluated at 1, 24, and 48 hours after surgery. RESULTS: There were no significant differences in patient demographics, duration of surgery and anesthesia or intra-operative opioids administration. We did not find any significant differences in the mean infusion rate of intraoperative remifentanil or postoperative fentanyl or in the side effects between the groups, but we did find a significant difference in the NRS between the groups. CONCLUSIONS: Based on our results, we conclude that a small dose of ketamine (0.5-2.5 µg/kg/min) proportional to fentanyl is not only safe, but also lowers postoperative pain intensity in patients undergoing spinal fusion, although the opioid-sparing effects of ketamine were not demonstrated.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408516/?tool=pubmed
Comparación del efecto preventivo de la ketamina rectal y del acetaminofen rectal después de amigdalectomía en niños
Comparison of the Preventive Analgesic Effect of Rectal Ketamine and Rectal Acetaminophen after Pediatric Tonsillectomy.
Heidari SM, Mirlohi SZ, Hashemi SJ.
Department of Anesthesiology and Intensive Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Int J Prev Med. 2012 Mar;3(Suppl1):S150-S155.
Abstract
OBJECTIVES: There is a little data about rectal administration of Ketamine as a postoperative analgesic, so we compared the efficacy of rectal ketamine with rectal acetaminophen, which is applied routinely for analgesia after painful surgeries like tonsillectomy.METHODS: In this single-blinded comparative trial, we enrolled 70 children undergoing elective tonsillectomy, and divided them randomly in two groups. Patients received rectal ketamine (2 mg / kg) or rectal acetaminophen (20 mg / kg) at the end of surgery. The children's Hospital of Eastern Ontario Pain scale was used to estimate pain in children. Also the vital signs, Wilson sedation scale, and side effects in each group were noted and compared for 24 hours. RESULTS: The ketamine group had a lower pain score at 15 minutes and 60 minutes after surgery in Recovery (6.4 ± 0.8, 7.4 ± 1 vs. 7.1 ± 1.2, 7.8 ± 1.2 in the acetaminophen group, P < 0.05) and one hour and two hours in the ward (7.2 ± 0.7, 7 ± 0.5 vs. 7.9 ± 1.2, 7.5 ± 1.2 in the acetaminophen group, P < 0.05), with no significant differences till 24 hours. Dreams and hallucinations were not reported in the ketamine group. Systolic blood pressure was seen to be higher in the ketamine group (104.4 ± 7.9 vs. 99.8 ± 7.7 in the acetaminophen group) and nystagmus was reported only in the ketamine group (14.2%). Other side effects were equivalent in both the groups. CONCLUSIONS: With low complications, rectal ketamine has analgesic effects, especially in the first hours after surgery in comparison with acetaminophen, and it can be an alternative analgesic with easy administration in children after tonsillectomy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399302/?tool=pubmed
Comparación de los efectos de la infiltración peritonsilar de ketamina y tramadol sobre el dolor post amigadalectomía: estudio doble ciego, randomizado, controlado y placebo
Comparison of peritonsillar infiltration effects of ketamine and tramadol on post tonsillectomy pain: a double-blinded randomized placebo-controlled clinical trial.
Ayatollahi V, Behdad S, Hatami M, Moshtaghiun H, Baghianimoghadam B.
Department of Anesthesiology, Shahid Sadoughi Hospital, Bou ali BLVD, 8916886938 Yazd, Iran.
Croat Med J. 2012 Apr;53(2):155-61.
Abstract
AIM: To assess the effect of peritonsillar infiltration of ketamine and tramadol on post tonsillectomy pain and compare the side effects. METHODS: The double-blind randomized clinical trial was performed on 126 patients aged 5-12 years who had been scheduled for elective tonsillectomy. The patients were randomly divided into 3 groups to receive either ketamine, tramadol, or placebo. They had American Society of Anesthesiologists physical status class I and II. All patients underwent the same method of anesthesia and surgical procedure. The three groups did not differ according to their age, sex, and duration of anesthesia and surgery. Post operative pain was evaluated using CHEOPS score. Other parameters such as the time to the first request for analgesic, hemodynamic elements, sedation score, nausea, vomiting, and hallucination were also assessed during 12 hours after surgery. RESULTS: Tramadol group had significantly lower pain scores (P=0.005), significantly longer time to the first request for analgesic (P=0.001), significantly shorter time to the beginning of liquid regimen (P=0.001), and lower hemodynamic parameters such as blood pressure (P=0.001) and heart rate (P=0.001) than other two groups. Ketamine group had significantly greater presence of hallucinations and negative behavior than tramadol and placebo groups. The groups did not differ significantly in the presence of nausea and vomiting. CONCLUSION: Preoperative peritonsillar infiltration of tramadol can decrease post-tonsillectomy pain, analgesic consumption, and the time to recovery without significant side effects.
http://neuron.mefst.hr/docs/CMJ/issues/2012/53/2/cmj_53_2_ayatollahi_22522994.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
No hay comentarios:
Publicar un comentario