A review of the clinical applications of ketamine in pediatric oncology

Prakash, Sathya; Gupta, Aditya; Meena, Jagdish Prasad; Seth, Rachna

doi:10.1002/pbc.28785

Cited by 6 publications

(4 citation statements)

References 110 publications

(170 reference statements)

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“…Complications of ketamine-based anesthesia in children radiotherapy were 23 -24% in previous studies, comprising inadequate movement control, sialorrhea, and slow recovery (7,33). Furthermore, ketamine had the highest number of complications in a recently conducted review with a 24% overall rate (7,33). Our study used ketamine intramuscular, and ketamine + midazolam was the leading cause of delay in consciousness return, insufficient motionlessness, nausea, vomiting, and patient discharge from the recovery.…”

Section: Discussionmentioning

confidence: 64%

“…Thus, the anesthesia technique was modified from intravenous approach to Intra muscle technique (IM ketamine). Complications of ketamine-based anesthesia in children radiotherapy were 23 -24% in previous studies, comprising inadequate movement control, sialorrhea, and slow recovery (7,33). Furthermore, ketamine had the highest number of complications in a recently conducted review with a 24% overall rate (7,33).…”

Section: Discussionmentioning

confidence: 94%

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The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

et al. 2022

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Background: Children with brain tumors experience potential neurologic complications when are treated with radiotherapy, especially if done frequently under anesthesia. Objectives: This study aimed to evaluate the neurologic complications associated with anesthesia in pediatrics treated with radiotherapy under anesthesia. Methods: This cross-sectional study consisted of 133 pediatric patients with a brain tumor who needed anesthesia for performing radiotherapy and were referred to Omid Charity Hospital and Imam Khomeini University Hospital from 2014 to 2020 by the census. Statistical values less than 0.05 were considered significant (P < 0.05). Results: The patients were in range of 1 - 8 years, and the number of 3,208 anesthesia inductions were conducted for daily radiotherapy. Major complications such as stroke, arrhythmia, tachyphylaxis, and aspiration were not observed. There was a significant relationship between the tumor side, anesthesia, and neurologic complications (P < 0.05). No significant differences were found between demographic data (age, sex, and weight) (P > 0.05). Conclusions: Anesthesia complications in this study were slight and insignificant. Some were either due to the tumor effect on other vital organs or prior exposure to radiotherapy and chemotherapy. Thus, for providing safe anesthesia, considering the tumor effect on body organs and neurologic complications caused by it can be a great help to reduce anesthesia complications in pediatrics under radiotherapy.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 94%

The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

et al. 2022

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“…The administration of general anesthesia alone is known to impair immune function; however, the addition of pectoral nerve II block under general anesthesia increases the proportion of NK cells, improves tumor cell killing activity, and upregulates postoperative IL-2 concentration in patients’ plasma ( 42 ). Ketamine, a dissociative anesthetic agent with excellent analgesic properties and a favorable safety profile, effectively reduces postoperative pain, blunts hyperalgesia, lowers opiate consumption, and even decreases chronic persistent postoperative pain ( 43 , 44 ). However, ketamine has tumor modulatory and anti-inflammatory effects, including, promoting tumor growth via decreasing NK cells and increasing tumor cell retention ( 35 ) and generally inducing immunosuppression ( 45 ).…”

Section: Perioperative Factors Associated With Cancer Promotionmentioning

confidence: 99%

Application of Anesthetics in Cancer Patients: Reviewing Current Existing Link With Tumor Recurrence

Liu

Wang

2022

Front. Oncol.

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Surgery remains the most effective cancer treatment, but residual disease in the form of scattered micro-metastases and tumor cells is usually unavoidable. Whether minimal residual disease results in clinical metastases is a function of host defense and tumor survival and growth. The much interesting intersection of anesthesiology and immunology has drawn increasing clinical interest, particularly, the existing concern of the possibility that the perioperative and intraoperative anesthetic care of the surgical oncology patient could meaningfully influence tumor recurrence. This paper examines current data, including recent large clinical trials to determine whether the current level of evidence warrants a change in practice. Available pieces of evidence from clinical studies are particularly limited, largely retrospective, smaller sample size, and often contradictory, causing several questions and providing few answers. Recent randomized controlled clinical trials, including the largest study (NCT00418457), report no difference in cancer recurrence between regional and general anesthesia after potentially curative surgery. Until further evidence strongly implicates anesthesia in future clinical trials, clinicians may continue to choose the optimum anesthetic-analgesic agents and techniques in consultation with their cancer patients, based on their expertise and current best practice.

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“…1 The efficacy of various routes of administration such as intravenous, intramuscular, oral, intranasal, rectal, and transdermal has been proven. 2 The high-dose intravenous form of ketamine is used clinically in short-term surgical procedures, and the low dose is used to create an analgesic effect. 3,4 It has been shown that ketamine at sub-anesthetic doses has rapid, strong antidepressant effects in patients with resistant depression.…”

Section: Introductionmentioning

confidence: 99%

Effects of ketamine, thiopental and their combination on the rat liver: A biochemical evaluation

et al. 2021

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Background. In the literature, it has been suggested that ketamine-related oxidative organ damage results from increased blood adrenaline level, and thiopental-related oxidative damage is caused by decreased adrenaline level, suggesting that ketamine-thiopental combination (KT) may be beneficial in reducing the hepatotoxic effect of ketamine.Objectives. To biochemically investigate the effects of ketamine, thiopental and KT on the liver in rats. Materials and methods.Male albino Wistar type rats received intraperitoneally (ip.) 30 mg/kg ketamine in the ketamine alone (KG) group (n = 6), 15 mg/kg thiopental in the thiopental alone (TG) group (n = 6), and 30 mg/kg ketamine + 15 mg/kg thiopental in the ketamine+thiopental (KTG) group (n = 6). The same volume of distilled water as solvent was given to the healthy (HG) animal group. This procedure was repeated once daily for 30 days. At the end of this period, the animals were killed by decapitation and their livers were removed. In liver tissue, malondialdehyde (MDA), total glutathione (tGSH), total oxidant status (TOS), total antioxidant status (TAS), tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin-6 (IL-6) levels were measured. The IL-1β, IL-6, TNF-α, adrenalin (ADR), noradrenalin (NDR), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were determined in blood samples taken from the tail veins.Results. In the group treated with ketamine and thiopental alone, MDA, TOS, IL-1β, IL-6, TNF-α, ADR, NDR, ALT, and AST levels were found to be high, and those of tGSH and TAS to be low. However, there was no significant change in the levels of these parameters in the KTG.Conclusions. These results indicate that oxidative stress and inflammation developed in the liver tissue of the group that used ketamine and thiopental alone, suggesting that the KT form may be safer in terms of toxicity in the clinical usage.

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A review of the clinical applications of ketamine in pediatric oncology

Cited by 6 publications

References 110 publications

The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

The Neurologic Complications Associated with Anesthesia in Pediatrics Treated with Radiotherapy Under Anesthesia

Application of Anesthetics in Cancer Patients: Reviewing Current Existing Link With Tumor Recurrence

Effects of ketamine, thiopental and their combination on the rat liver: A biochemical evaluation

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