Online ISSN: 2515-8260

Keywords : Ketamine


Ketamine infusion for postoperative analgesia in asthmatics: A comparison with intermittent Tramadol

Dr. Mohammad Ilyas, Dr. Satyendra Uike, Dr.Akhilesh Chaudhary, Dr. Ajay Singh

European Journal of Molecular & Clinical Medicine, 2023, Volume 10, Issue 1, Pages 1416-1419

Background: Narcotics when used for postoperative analgesia may release histamine and cause bronchospasm in asthmatic patients. The present study was conducted to compare ketamine and tramadol for postoperative analgesia in asthmatics.
Materials & Methods: 60 asthmatic patients of both genders were divided into 2 groups of 30 each. Group I received ketamine-midazolam infusion preceded by a bolus of ketamine 0.5 mg-kg-' IV. Group II received a bolus dose of tramadol (2 mg/kg) followed by an intravenous infusion (0.2 mg · kg−1· h−1) postoperatively. Parameters such as Forced vital capacity in 1 s (FEV1), respiratory rate, pain score in minutes and sedation score was compared.
Results: Group I had 16 males and 14 females and group II had 12 males and 18 females. There was significant difference in respiratory rate and non- significant difference in forced vital capacity in 1 s (%) and pain score in minute in both groups. The mean sedation score at baseline was 3.2 in group I and 5.2 in group II, at 1 hour was 2.5 in group I and 4.7 in group II, at 2 hours was 2.3 in group I and 3.4 in group III and 1.7 in group I and 2.8 in group II. The difference was significant (P< 0.05).
Conclusion: Both Ketamine and tramadol infusion can provide a safe alternative to the usual parenteral narcotic therapy in asthmatics in terms of analgesia

Comparative study of ketamine and fentanyl with bupivacaine in spinal anaesthesia in patients undergoing total abdominal hysterectomy

Dr Gunjan Katiyar, Dr Sunil Rasiklal Joshi, Dr Vivek Singh

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2215-2219

Background: Spinal anaesthesia is preferred technique for conducting abdominal hysterectomy, but it is insufficient to provide post-operative analgesia adequately. The addition of local anaesthetic adjuvants increases subarachnoid block efficacy and prolongs postoperative analgesia. Due to its fast onset with a limited time of action with minimal cephalic spread, Fentanyl is preferred as an adjuvant in spinal anaesthesia. Adding Fentanyl to a low dose, Bupivacaine offers improved surgical anaesthesia and increased block reliability. Ketamine has several clinically useful properties, including analgesia and less cardiorespiratory depressant effects than other anaesthetic agents, in fact it causes some stimulation of the cardiovascular system.
Objectives: To compare the Duration of the postoperative analgesia (Time of 1st rescue Analgesic) between intrathecal administration of Ketamine and fentanyl with bupivacaine. To compare the duration and onset of sensory and motor block (modified bromage scale), the effect on hemodynamic parameter, Degree of sedation and side –effects (post-operative nausea and vomiting, pruritus, shivering, urinary retention and any other).
Methodology: Two group were included in this study i.e. Group A & Group B. Both group had 18 cases for total abdominal hysterectomy Group A(n=10)- received 15mg of Bupivacaine 0.5% along with Fentanyl 25 mcg intrathecally and Group B (n=10)-received 15mg of Bupivacaine 0.5% along with Ketamine 25 mgintrathecally. The onset of sensory and motor block, duration of block, hemodynamic parameter, sedation score, total postoperative analgesia time, and side effects if any will be recorded.
Results: Demographic variables were compared between both groups A and B. Group A is A significant faster onset of sensory block was found in ketamine group in comparison to fentanyl group. (p-value<0.001). While the time to achieve the highest level of sensory block was found to be almost similar in both the groups.
Conclusion: ketamine or fentanyl to spinal bupivacaine were equally effective in pain control after abdominal hysterectomy

Comparative assessment of Levobupivacaine Alone versus Levobupivacaine with Ketamine in Subcutaneous Infiltration for Postoperative Analgesia

Dr Rohit Kansal, Dr Ankur Garg, Dr Dinesh Kumar Sardana

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 8927-8933

Introduction: After a lower segment caesarean section, local anaesthetic wound infiltration is used as part of multimodal analgesia to lessen pain and opiate use (LSCS). Ketamine extends the effects of analgesia by blocking additional spinal pain pathways.
Aims: To compare the analgesic effectiveness of ketamine and levobupivacaine when injected into subcutaneous wounds.
Materials and Methods: 50 patients receiving under spinal anaesthetic, a randomisedwas done. Both Group A and Group B parturients received surgical wound infiltration with 0.5% levobupivacaine diluted with normal saline at a dose of 2 mg/kg body weight for Group A, and 0.5% levobupivacaine with ketamine at a dose of 1 mg/kg body weight for Group B. We evaluated postoperative pain scores, first rescue analgesia time (FRA), hemodynamic parameters, and overall opioid analgesic use.
Results: Group B had a 1.5-hour longer pain-free duration and shorter time to FRA, along with lower mean VAS scores. Additionally, Group B participants consumed significantly fewer opioids overall and overall pain levels (P = 0.003). 97% of parturients in Group A and just 50% of those in Group B required rescue analgesia. The patient satisfaction score in Group B was considerably higher (P = 0.009). Between the groups, there was no difference in the frequency of nausea and vomiting (P = 0.5234).
Conclusions: Adding ketamine to levobupivacaine for surgical wound infiltration increases patient satisfaction, prolongs the duration of analgesia, and reduces the need for 24-hour opioid use.

Comparison of Nebulized Dexmedetomidine Versus Combination Of Nebulized Ketamine And Midazolam For Premedication In Pediatric patients Undergoing Elective Surgery-A Randomized Double Blinded Study

Archana Endigeri, Mahindra Kalashetty,Ranganath Channappagoudar,Ganeshnavar Anilkumar,Subhash Reddy,Kelageri Satish, Vidya B C.,Shweta Lamani,Ganeshnavar Anilkumar

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 18-29

Background & Aims: We compared  dexmedetomidine with combination of midazolam and ketamine via nebulization for sedation in pediatric patients posted for elective surgery
Methods: Ethical clearance followed by informed consent was taken from guardians. Sixty was our sample size which was divided into two groups of 30 per group. Group A   received dexmedetomidine 2µg/kg & Group B received midazolam 0.1 mg/kg with ketamine 1 mg/kg. The primary objective was mask acceptance scale. Secondary objectives were sedation score, parental separation anxiety scale, post operative emergence agitation, recovery times and side effects. The MS EXCEL was used for data entry & outcomes averaged as Mean with standard deviation (SD) or Median with inter quartile range (IQR). Chi‑square test/ Fisher Exact test, Independent t‑test/Mann‑Whitney U test was used. P < 0.05 was regarded as remarkable.

Ketamine in Treatment Refractory OCD – A Case Series

Hiral Kotadia, Ayushi Soni

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 3, Pages 1377-1381

Obsessive: Compulsive Disorder (OCD) is a chronic debilitating neuropsychiatric disorder, affecting 2% of global population and 0.6 % of Indian population. Treatment Refractory OCD (TR-OCD) is defined as poor response to serotonergic drugs, augmenting antipsychotics and behavioural therapy at optimal dose and duration.
Various receptors involved in OCD are serotonergic, dopaminergic, glutaminergic (N-Methyl-D-Aspartate - NMDA) and Gamma Amino Butyric Acid receptors. There is significant evidence regarding the role of serotonergic and dopaminergic receptors in neurobiology of OCD. Though the research in the role of glutamate and glutaminergic receptors in OCD is emerging, the current evidence regarding same is still limited. Along with this, research regarding the role of NMDA receptor inhibitors in treatment of OCD is also limited to few case reports. Ketamine is an inhibitor of the NMDA receptor. Ketamine has been used in treatment resistant depression. However, there is dearth of literature regarding use of ketamine in TR-OCD.
Here we present 3 cases of TR-OCD responding to ketamine. The possible role of glutaminergic receptors in neurobiological mechanism of OCD is also discussed

Comparison of IV dexmedetomidine & propofol versus IV dexmedetomidine & ketamine for daycare urological procedures: a randomized controlled study

Dr. Suresh Janapati,Dr. Kiran Kumar Suggala, Dr. DasariSamyuktha

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 964-972

Background: Most urologic surgeries are performed in a narrow, limited space with
minimally invasive technique or cystoscope& anaesthesia for these procedures is
administered with the goals of safety, satisfactory procedural condition for the performance
of therapeutic or diagnostic procedures ensuring rapid recovery with minimal post-operative
complications. Therefore, we decided to compare the efficacy & safety of IV Propofol @1.5
mg/kg +Dexmedetomidine @1μg/kg versus IV Ketamine @ 1mg/kg + Dexmedetomidine @
1μg/kg in providing procedural sedation in urological procedures.
Material & Methods: This prospective randomized study was conducted in Department of
Anaesthesiology of Mamata medical hospital. In this study 50 patients scheduled for elective
daycare urological procedures were included and divided equally in two groups. Group Areceived
IV Propofol 1.5 mg/kg, then infusion of Dexmedetomidine@ 1μg/kgand group Breceived
IV Ketamine 1mg/kg, then Dexmedetomidine@ 1μg/kg.
Results: In our study, there is no significant difference in age, weight, gender. The
comparison of mean between two groups after giving dexmedetomidine was statistically
significant (p< 0.05) in heart rate, SBP, onset, duration of analgesia, VAS & Ramsay scores
but DBP & SpO2 was statistically not significant.
Conclusion: Comparison of baseline & intraoperative hemodynamics, showed that the values
were better maintained in Dexmedetomidine + propofol (Group-A) than Dexmedetomidine +
Ketamine (Group B). We have concluded that Dexmedetomidine + Propofol combination was
superior to Dexmedetomidine + Ketamine, providing early onset of sedation, prolonged
analgesia & stable intraoperative hemodynamics.

Study on efficacy of Ketamine and Ondansetron for Prevention of Shivering during Anesthesia

Dr.Shilpa Sharda

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 1, Pages 772-776

Background: The use of anesthetics and opioids leads to motor and behavioral
inhibition, body movements and consequently a decrease in body temperature, which
results in shivering. So, the objective of this study to evaluate the efficacy Of Ketamine
and Ondansetron for prevention of shivering during anesthesia.
Materials and Methods: Total 120 cases were included in this study. We were divided in
to 2 groups. This study was conducted in the Department of Anaesthesia in Pacific
Medical College and Hospital.
Results: We were included 120 cases in this study. Among all 70 were female and rest
were male. We were divided in to three group which were Ketamine (60) &
Ondansetron (60). We were found in this study, the frequency of shivering in the groups
who received Ketamine was significantly lower than the Ondansetron group.
Conclusion: This study concludes that, Ketamine in dose of 0.25mg/kg has been found
to be significantly more effective than ondansetron (4mg) during spinal anesthesia.

COMPARATIVE STUDY OF PROPOFOL WITH KETAMINE AND PROPOFOL WITH BUTORPHANOL FOR TOTAL INTRAVENOUS ANAESTHESIA IN SHORT SURGICAL PROCEDURES

Dr. Matturu Soumya; Dr. Amol Singam

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 7, Pages 2083-2090

Background: Total intravenous anaesthesia is technique which uses various drugs in combination, given exclusively by IV route to provide general anaesthesia to the patient. TIVA provides a good surgical plane, rapid induction, smooth the emergence from anaesthesia and rapid recovery. Thus making it a desirable alternative for day care surgeries. Propofol is IV anaesthetic agent, having a pharmacological profile favorable for TIVA. However it is known to cause respiratory depression and dose-dependent hypotension, and due its lack of analgesic properties there is a limitation on its employment. Ketamine known for its hypnotic, analgesic and amnesic properties. Butorphanol seems to provide good analgesia but is associated with adverse effects like cardio depressant action, dizziness and sedation.
Methods: A total of 60 patients who will be undergoing surgeries under TIVA in the age group of 20-60yrs will be taken up for this study. They would be further divided in two groups, Group PK will receive ketamine 1mg/kg 1 min prior to administration of propofol and propofol and group PB will receiving butorphanol 20μg/kg 1min prior to administration of propofol. Propofol will be given at a dose of 1.5ml/kg to both the groups during induction . In both the groups anaesthesia will be maintained with propofol 9mg/kg/hr . Patient will be monitored for various parameters such as non-invasive heamodynamic, respiratory parameters. Incidence of pain on injection Propofol, post-operative sedation, nausea, vomiting will also be looked for.
Results and Conclusion : Expected outcome of this study is that the combination of Propofol-ketamine, offers a better haemodynamic and respiratory stability over propofol- butorphanol combination. Pain on injection will be better attenuated by butorphaol than ketamine.

Effect of ketamine as an adjunct to opioid for pain control in traumatic patients

Mehdi Arzani Shamsabadi; Mohammad Darvishi; Masoud Shahabian; Seyed Zia Hejripour

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4438-4443

Background: Pain management results in better outcomes in traumatic patients in the emergency ward. Use of non-opioids facilitates the elimination of the adverse effects of opioid. Regarding this, the present study was conducted to examine the effect of ketamine as an adjunct to opioids for pain control in traumatic patients in a tertiary healthcare center in Tehran, Iran. Methods and materials: This double-blind randomized clinical trial was conducted on 160 traumatic patients admitted to the Emergency Department of Besat Hospital, Tehran, Iran, in 2018. The study population was randomly assigned into two groups of intervention and placebo. The intervention group one of which received 0.05 mg/kg opioid (i.e., morphine) plus 0.1 mg/kg ketamine, and placebo group the other one was provided with the same amount of morphine opioid plus placebo. The pain was recorded up to 120 min and compared between the groups. Results: Based on the obtained results, 23 (28.8%) and 16 (20%) patients in the ketamine intervention and control placebo groups had side effects, respectively, showing no significant difference (P=0.197). In addition, the pain significantly reduced in both groups (P=0.001). However, the results of repeated measures ANOVA revealed no statistically significant difference between the two groups in terms of pain reduction trend (P=0.275). Conclusion: Based on the results, it can be concluded that ketamine has no superior effect when administered as an adjunct to opioid for pain control in traumatic patients.