Can Intraoperative Low-Dose R,S-Ketamine Prevent Depressive Symptoms After Surgery? The First Meta-Analysis of Clinical Trials

Pang, Liwei; Cui, Meiying; Dai, Wanling; Kong, Jing; Chen, Hongzhi; Wu, Shuodong

doi:10.3389/fphar.2020.586104

Cited by 11 publications

(7 citation statements)

References 74 publications

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“…In several previous reviews, the administration of perioperative low-dose ketamine has demonstrated an opioidsparing effect in patients undergoing major surgery and could mitigate opioid-induced hyperalgesia and acute opioid tolerance shown to occur in these patients [2,54,55]. However, these literature focused on a broad range of surgical procedures, whether this hold true for spine surgery remained controversial.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Low-Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhou

Yang

Hai

et al. 2022

Pain Research and Management

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Objective. Although low-dose ketamine has been shown to be generally beneficial in terms of pain control in a variety of major surgery, there is no consensus regarding the effectiveness of supplemental ketamine analgesic use exclusively in spine surgery. The objective of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess the efficacy and safety of perioperative low-dose ketamine for pain management and analgesic consumption in patients undergoing spine surgery. Methods. A comprehensive literature search was performed for relevant studies using PubMed, EMBASE, Web of Science, and Cochrane Library. Patients who received perioperative low-dose ketamine were compared to the control group in terms of postoperative pain intensity, opioid consumption, and adverse events. Patients were further categorized by ages and administration times for subgroup analysis. Results. A total of 30 RCTs comprising 1,865 patients undergoing elective spine surgery were included. Significantly lower pain intensity and less opioid consumption at 12 h, 24 h, and 48 h postoperatively and lower incidence of postoperative nausea and vomiting (PONV) were observed in the ketamine group (all P < 0.05 ). There was no significant difference of central nervous system (CNS) adverse events between groups. However, different efficacy of low-dose ketamine was detected when patients were categorized by ages and administration times. Conclusion. Perioperative low-dose ketamine demonstrated analgesic and morphine-sparing effect with no increased adverse events after spine surgery. However, this effect was not significant in pediatric patients. Only postoperative or intraoperative and postoperative administration could prolong the analgesic time up to 48 h postoperatively. Further studies should focus on the optimal protocol of ketamine administration and its effect on old age participants.

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Section: Discussionmentioning

confidence: 99%

Perioperative Low-Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Zhou

Yang

Hai

et al. 2022

Pain Research and Management

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“…Previous studies regarding cesarean section have suggested that LDSK can not only relieve pain but also play an antidepressant role, which may also be the reason for the low incidence of PONV and high satisfaction rate of two S‐ketamine groups. Its antidepressant effect is highly related to the activation of the α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazole‐propionicacid (AMPA) receptor 23,24 . According to the questionnaire, the main causes of dissatisfaction were pain and a high incidence of PONV, which also suggests that our anesthesia decision‐making still needs to be improved.…”

Section: Discussionmentioning

confidence: 99%

Effects of subanesthesia dose S‐ketamine induction on postoperative psychiatric complications after gynecological surgery

Zhang

Ding

Luo

et al. 2022

Ibrain

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Ketamine may become an important drug for multimodal analgesia regime again because of its strong analgesic effects and retaining the advantage of spontaneous breathing. The present study was designed to explore the influences of different dosages of S-ketamine anesthesia induction regimes on psychiatric complications and postoperative prognosis in patients undergoing gynecological operations. In this prospective, triple-blinded, randomized, controlled study, patients undergoing elective gynecological surgery were randomized to one of three treatment groups: low-dose S-ketamine (LDSK) group (a 0.3 mg/kg bolus for anesthesia induction), minimal-dose S-ketamine (MDSK) group (a 0.2 mg/kg bolus for anesthesia induction), and placebo (CON) group (a saline bolus for anesthesia induction). The main outcome measures were as follows: intraoperative vital signs, extubation time, anesthesia recovery time and postanesthesia care unit (PACU) stay duration, incidence of psychiatric complications, Ramsay sedation scale (RSS) 1, 2, 24, and 48 h, postoperatively, and overall prognosis. One hundred and eighty female participants were finally included in this study from April 2021 to December 2021. Significant differences were not observed in age, height, weight, American Society of Anesthesiologists physical status classification, or history of mental illness between the groups. No statistically significant differences were discovered with regard to intraoperative vital signs, extubation time and PACU stay duration, incidence of psychiatric complications, and RSS scores at 1, 2, 24, and 48 h postoperatively in the three groups. However, the visual analog scale (VAS) scores of the CON group at 10 min after extubation and at the time point leaving PACU were much higher than that of the LDSK and MDSK groups. The VAS scores at 48 h after surgery

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“…A new intranasal formulation of isomeric ketamine (S-ketamine or esketamine) was recently approved by the Food and Drug Administration for treatment-resistant depression [59 ▪ ]. However, the early randomized trials using intraoperative, low dose, racemic ketamine show no benefit in the prevention of postoperative depression or delirium [60 ▪▪ ]. There is no evidence to recommend alterations to a patient's regularly prescribed ketamine regimen in the perioperative period.…”

Section: Perioperative Psychotropic Medication Managementmentioning

confidence: 99%

Patients with psychiatric disease: implications for anesthesiologists

Guthrie

Richman

2021

Current Opinion in Anaesthesiology

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Purpose of reviewPsychiatric illness is common in patients presenting for surgery. Overall health and surgical outcomes are adversely affected by the presence of psychiatric comorbidities. Recent findingsAs new treatment modalities become available, their perioperative implications need to be evaluated. These implications include drug-drug interactions, hemodynamic effects, bleeding risk, and factors affecting perioperative exacerbation of the underlying psychiatric illness.

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Can Intraoperative Low-Dose R,S-Ketamine Prevent Depressive Symptoms After Surgery? The First Meta-Analysis of Clinical Trials

Cited by 11 publications

References 74 publications

Perioperative Low-Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Perioperative Low-Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effects of subanesthesia dose S‐ketamine induction on postoperative psychiatric complications after gynecological surgery

Patients with psychiatric disease: implications for anesthesiologists

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