Analgesia con ketamina/Ketamine analgesia

Gárgaras profilácticas con ketamina para reducir el dolor postoperatorio de garganta después de la intubación endotraqueal.


Prophylactic ketamine gargle to reduce post-operative sore throat following endotracheal intubation.
Rajkumar G, Eshwori L, Konyak P Y, Singh L D, Singh TR, Rani M B.
J Med Soc [serial online] 2012 [cited 2013 Jun 10];26:175-9.
Abstract
Objective: To study, the effect of prophylactic ketamine (K) gargle in reduction of post-operative sore throat (POST) following endotracheal intubation. Materials and Methods: 90 adult patients between 18 years and 60 years with American Society of Anesthesiologists I and II, scheduled for elective open cholecystectomy surgery under general anesthesia were randomly assigned into 2 groups of 45 patients each. Group S-received 30 ml of normal saline (NS) and Group K-received 40 mg of K in 30 ml of NS. Then the patients were asked to gargle with the preparation for 30 s after their arrival in the operation room. Anesthesia was induced 5 min later. On arrival in the post-anesthesia care unit (0 h), and at 2 h, 4 h, and 24 h thereafter, the patients were questioned by a blinded investigator whether he/she had experienced sore throat or any other side- effects. POST was graded on a four-point scale (0-3). Results: The incidence of POST was higher in NS group compared with K group at 0 h, 2 h, 4 h, and 24 h. In addition, there is reduced incidence of hoarseness of voice in K group compared to NS group at 0 h, 2 h, 4 h, and 24 h after extubation. Conclusion: In conclusion, gargling with K decreases the incidence and severity of POST and hoarseness of voice.
Keywords: Endotracheal intubation, Ketamine, Post-operative, Sore throat
http://www.jmedsoc.org/text.asp?2012/26/3/175/113242


Analgesia prehospitalaria con S-ketamina nasal. Una serie de casos

Prehospital analgesia using nasal administration of S-ketamine - a case series.
Johansson J, Sjöberg J, Nordgren M, Sandström E, Sjöberg F, Zetterström H.
The research and development unit, Jämtland county council, Östersund, Sweden. joakim.johansson@jll.se.
Scand J Trauma Resusc Emerg Med. 2013 May 14;21:38. doi: 10.1186/1757-7241-21-38.
Abstract
Pain is a problem that often has to be addressed in the prehospital setting. The delivery of analgesia may sometimes prove challenging due to problems establishing intravenous access or a harsh winter environment. To solve the problem of intravenous access, intranasal administration of drugs is used in some settings. In cases where vascular access was foreseen or proved hard to establish (one or two missed attempts) on the scene of the accident we use nasally administered S-Ketamine for prehospital analgesia. Here we describe the use of nasally administered S-Ketamine in 9 cases. The doses used were in the range of 0,45-1,25 mg/kg. 8 patients were treated in outdoor winter-conditions in Sweden. 1 patient was treated indoor. VAS-score decreased from a median of 10 (interquartile range 8-10) to 3 (interquartile range 2-4). Nasally administered S-Ketamine offers a possible last resource to be used in cases where establishing vascular access is difficult or impossible. Side-effects in these 9 cases were few and non serious. Nasally administered drugs offer a needleless approach that is advantageous for the patient as well as for health personnel in especially challenging selected cases. Nasal as opposed to intravenous analgesia may reduce the time spent on the scene of the accident and most likely reduces the need to expose the patient to the environment in especially challenging cases of prehospital analgesia. Nasal administration of S-ketamine is off label and as such we only use it as a last resource and propose that the effect and safety of the treatment should be further studied.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660173/pdf/1757-7241-21-38.pdf



Administración preincisional intravenosa o subcutánea de dosis bajas de ketamina para suprimir el dolor postapendicetomía
Preincisional administration of intravenous or subcutaneous infiltration of low-dose ketamine suppresses postoperative pain after appendectomy.
Honarmand A, Safavi M, Karaky H.
Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
J Pain Res. 2012;5:1-6. doi: 10.2147/JPR.S26476. Epub 2011 Dec 30.
Abstract
BACKGROUND: Ketamine, an N-methyl-D-aspartate receptor antagonist, can suppress hyperalgesia and allodynia. The purpose of the present study was to evaluate the clinical efficacy of preincisional intravenous or subcutaneous infiltration of ketamine for postoperative pain relief after appendectomy. METHODS: Ninety patients, aged 18-60 years, scheduled for appendectomy was enrolled in this study. Patients were divided into three groups of 30 each and received subcutaneous infiltration of ketamine 0.5 mg/kg (KS), intravenous ketamine 0.5 mg/kg (KI), or subcutaneous infiltration of normal saline 3 mL (C) before surgery. Visual analog scale (VAS) values and analgesic consumption were evaluated for 24 hours after surgery. RESULTS: VAS scores were significantly lower at the time of arrival in the recovery room, and at 10, 20, and 30 minutes thereafter in group KI and group KS compared with group C (P < 0.05). VAS scores were not significantly different between group KI and group KS at these intervals. Postoperative VAS scores were significantly lower at 6, 12, 18, and 24 hours in group KI compared with group C (P < 0.05). In group KS, the postoperative VAS score was significantly lower at 6 hours (P < 0.05). VAS scores were significantly lower at 12, 18, and 24 hours after surgery in group KI compared with group KS (P < 0.05). CONCLUSION: A 0.5 mg/kg dose of ketamine given at approximately 15 minutes before surgery by the intravenous route provided analgesia for 24 hours after surgery in patients undergoing appendectomy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273401/pdf/jpr-5-001.pdf






Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org