A review on the recent application of ketamine in management of anesthesia, pain, and health care

Abdollahpour, Abolfazl; Saffarieh, Elham; Zoroufchi, Babak Hosseinzadeh

doi:10.4103/jfmpc.jfmpc_875_19

Cited by 25 publications

(16 citation statements)

References 69 publications

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“…NSAIDs are the most prescribed analgesic drugs in the world, and their efficacy in the treatment of acute pain has been repeatedly demonstrated [ 4 , 29 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Traumatic Pain in the Emergency Department

et al. 2023

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Trauma is a major cause of mortality throughout the world. Traumatic pain—acute, sudden, or chronic—is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Patients’ perceptions of pain assessment and management have become an important criterion and relevant outcome measure for healthcare institutions. Several studies show that 60–70% of ER patients experience pain, and more than half of them express a feeling of sorrow, which can be moderate or severe, at triage. The few studies that have analyzed how pain is assessed and managed in these departments agree that approximately 70% of patients receive no analgesia or receive it with remarkable delay. Specifically, less than half of the patients receive treatment for pain during admission and 60% of discharged patients have higher intensity pain than at admission. Trauma patients are also the ones who most commonly report low satisfaction with pain management. Associated with this lack of satisfaction, we can describe the poor use of tools for measuring and recording pain, poor communication among caregivers, inadequate training in pain assessment and management, and widespread misconceptions among nurses about the reliability of patients’ estimation of pain. The aim of this article is to review the scientific literature to explore the methodologies of pain management in trauma patients attending the emergency room and analyzing their weaknesses as a starting point to improve the approach to this, unfortunately too often, underestimated issue. A literature search was performed using the major databases to identify relevant studies in indexed scientific journals. The literature showed that the multimodal approach in trauma patients is the best approach to pain management. It is becoming increasingly crucial to manage the patient on multiple fronts. Drugs acting on different pathways can be administered together at lower doses, minimizing risks. Every emergency department must have staff trained in the assessment and immediate management of pain symptoms as this allows the reduction of mortality and morbidity and shortens hospital stays, contributing to early mobilization, reduced hospital costs, and enhanced patient satisfaction and quality of life.

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“…NSAIDs are the most prescribed analgesic drugs in the world, and their efficacy in the treatment of acute pain has been repeatedly demonstrated [ 4 , 29 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Traumatic Pain in the Emergency Department

et al. 2023

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“…It acts very fast, and relieves depression in less than 2 hours. In the approved nasal spray only the S (+) enantiomer is used [8,9].…”

Section: Clinical Uses Of Ketaminementioning

confidence: 99%

“…Other uses of ketamine with the low level of evidence are alcohol withdrawal, status epilepticus, and persistent bronchospasm in critical care settings [8].…”

Section: Clinical Uses Of Ketaminementioning

confidence: 99%

Use of Oral Ketamine in Palliative Care

Lopuh¹

2022

Ketamine Revisited - New Insights Into NMDA Inhibitors

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Ketamine, an N-methyl-D-Aspartate receptor antagonist, has been used for more than 50 years. From its initial potential as an anesthetic drug, its use has increased in the fields of pain medicine, psychiatry, and palliative care. It is available in different formulations, of which oral use is promising due to its active metabolite, norketamine which reaches 2–3 times higher levels when administered orally in comparison with parenteral use. Oral use is also more feasible and easier to use in settings, where medical staff is not that present, such as home care or hospices. Oral solution of ketamine has not yet been officially licensed for use although there have been several reports which recommend its use in neuropathic pain, severe depression, airway obstruction, and anxiety. Palliative care is defined as total care for patients whose diseases do not respond to curative treatment. It encompasses good control of physical symptoms, and psychological, social and spiritual problems. Patients often experience pain, despite high doses of opioids, depression and anxiety, and dyspnea. Oral ketamine does not have the side effects of opioids therefore it represents a good alternative. It may also reduce the need for high opioid doses and be more suitable for patients who wish to avoid the necessary sedation.

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“…Nowadays, ketamine is regarded as an essential adjuvant drug in palliative care in many countries. It can be administered in various regimens through oral, intravenous, intrathecal, subcutaneous, and topical routes of administration [ 34 ]. A recently published Cochrane systematic review studying ketamine as an adjuvant to refractory cancer pain concluded that the current evidence is insufficient to assess the benefits and adverse effects of ketamine as an adjuvant to opioids.…”

Section: Consensus On Ketamine Use: What Does the Evidence Say?mentioning

confidence: 99%

“…Consensus: We found a moderate level of evidence suggesting the use of ketamine in chronic non-cancer pain, whereas most RCTs present a low level of evidence for its use in cancer pain. However, a large number of open label studies and retrospective case series advocate its use [ 34 – 37 ].…”

Section: Consensus On Ketamine Use: What Does the Evidence Say?mentioning

confidence: 99%

Comeback of ketamine: resurfacing facts and dispelling myths

Kumar

Kohli

2021

Korean J Anesthesiol

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Initially known as CI-581, ketamine was first synthesized in 1962 as a replacement for phencyclidine (PCP). It is being used since then as a profound anesthetic and analgesic, in addition has bronchodilating, sedative and amnestic properties with the preservation of airway reflexes and sympathetic nervous system tone. Ketamine is always a stimulating topic of discussion since its discovery as the controversies regarding its usage in certain set of patients mostly overpowers its boon. In past 50 years, despite of potential benefits it has not gained acceptable popularity because of concerns of "emergence phenomenon", its use as substance of abuse and systemic side effects. Since 2012, ketamine has been subject to three World Health Organization (WHO) reviews addressing its international control. Researchers are widely studying this wonder drug since a decade worldwide. Many myths of ketamine regarding emergence phenomenon, its use in traumatic brain injury, open eye injury is getting busted in recent times. It's again getting popular in pre-hospital settings, critical care, emergency medicine, low dose acute pain services & adjuvant in regional anesthesia techniques. This review will highlight the current consensus on the various applications of ketamine in the light of available evidence in the literature.

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A review on the recent application of ketamine in management of anesthesia, pain, and health care

Cited by 25 publications

References 69 publications

Acute Traumatic Pain in the Emergency Department

Acute Traumatic Pain in the Emergency Department

Use of Oral Ketamine in Palliative Care

Comeback of ketamine: resurfacing facts and dispelling myths

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