Plasma ketamine concentrations after diazepam and placebo pretreatment were examined in a double-blind, randomized, cross-over study. Eight healthy male subjects received either diazepam or a 0.9% NaCl placebo before ketamine and received the alternate combination 5 to 24 days later. Ten minutes before ketamine dosing, diazepam, 0.3 mg/kg, or placebo in equal volume was injected intravenously at a rate not exceeding 5 mg/min. Ketamine, 2.2 mg/kg iv, was injected over 1 min. For the clinically relevant period for anesthesia (1 to 30 min), diazepam-ketamine treatment resulted in higher plasma levels at most time points, but diazepam pretreatment did not alter plasma levels of metabolite KI and pseudometabolite KII nor the 24-hr urinary excretion of ketamine, KI, and KII. Ketamine kinetics followed a three-term exponential decline under both treatment conditions. After placebo-ketamine dosing, plasma t 1/2s were as follows: distribution (pi t 1/2) = 24.1 sec, redistribution (alpha t 1/2) = 4.68 min, and elimination (beta t 1/2) = 2.17 hr. After diazepam-ketamine dosing, t 1/2s were: pi t 1/2 = 25.0 sec, alpha t 1/2 6.37 min, and beta t 1/2 = 2.32 hr.
for intravenous regional anesthesia. Anesth Analg 1989;68:328-32. thetic, sensory, and motor blockade when injected into the isolated extremity, unpleasant psychotomimetic effects after the reltwse of the tourniquet limit the usefulness of this use of krtamine. Ketamine cannot be recommended for intravenous regional anesthesia unless these unpleasant side effects are a~o l i s~, e~ or corltroJled by ,neans of pl,armaco~ogic ad;uvnnts.We studied ketamine iritravenous regional anesthesia of the upper extremity in zdunteers using concentrations of 0.5%, 0.3%, and 0.2%. Ketamine 0.5 and 0.3% produced adequate intravenous regional anesthesia. Anesthesia was inadequate when a 0.2% concentration was used. However, although the 0.3% coilcentration provides coniplcte sympo-
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