Effect of intravenous S-ketamine on the MAC of sevoflurane: a randomised, placebo-controlled, double-blinded clinical trial

Hamp, Thomas; Baron, David M.; Krammel, Mario; Reiter, Birgit; Langauer, A.; Stimpfl, Thomas; Plöchl, Walter

doi:10.1016/j.bja.2018.08.023

Cited by 25 publications

(17 citation statements)

References 29 publications

(25 reference statements)

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“…Studies report that ketamine provides a significant reduction in the minimum alveolar concentration (MAC) of sevoflurane. 26 Although, animal studies show a decrease in the MAC of sevoflurane with ketamine administration, 27,28 there was no difference in intraoperative opioid and sevoflurane consumption in our study.…”

Section: Discussioncontrasting

confidence: 47%

Perioperative Intravenous Low-Dose Ketamine Infusion to Minimize Pain for Septorhinoplasty: A Prospective, Randomized, Double-Blind Study

et al. 2020

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Objectives: Studies investigating the effects of intravenous (IV) ketamine in pain management after septorhinoplasty is limited. This study aims to evaluate the efficacy of low-dose IV infusion of ketamine on pain scores. Methods: This randomized, prospective, double-blind study was conducted with 48 patients who underwent septorhinoplasty. Intravenous ketamine bolus (0.5 mg/kg) was administered to the ketamine group (group K, n = 24) at anesthesia induction, and ketamine infusion was continued (0.25 mg/kg/h) during the surgery. In the control group (group C, n = 24), the same protocol was administered using saline instead of ketamine. Furthermore, 50-mg dexketoprofen trometamol was administered to both groups 30 minutes before the end of the surgery. Then it was repeated at the 12th and 24th hours postoperatively. Pain scores were evaluated with the visual analogue scale. Consumptions intraoperative of opioid and sevoflurane, rescue opioid requirement, patient satisfaction, and side effects were recorded. Results: Pain scores were significantly lower in group K at all postoperative periods ( P < .05). There was no significant difference between the groups in terms of intraoperative sevoflurane and remifentanil consumptions ( P > .05). Rescue opioid analgesic requirements were significantly lower in group K than group C (0/24 vs 6/24, respectively; P = .022). Side effects were similar between the groups ( P > .05). Conclusion: We recommend the administration of low-dose ketamine infusion during septorhinoplasty surgery because it reduces the requirement for rescue opioid analgesia and postoperative pain scores.

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Section: Discussioncontrasting

confidence: 47%

Perioperative Intravenous Low-Dose Ketamine Infusion to Minimize Pain for Septorhinoplasty: A Prospective, Randomized, Double-Blind Study

et al. 2020

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“…We recruited adult patients with an American Society of Anesthesiologists physical status of 1–2 scheduled for elective surgery under general anesthesia. To standardize the noxious stimulus, we only included patients undergoing breast surgery, as this usually requires a skin incision of 3–5 cm at the trunk ( 6 ). The patients' age was restricted to 30–65 years, as the MAC is relatively uniform in this age group ( 7 ).…”

Section: Methodsmentioning

confidence: 99%

“…Next, the surgeon was asked to perform a single incision of 3 to 5 cm and then pause for 1 min before continuation of the operation. The response to the skin incision was counted as positive if the patient exhibited “gross purposeful movement of the head or at least one extremity” within 1 min after the skin incision ( 6 ). The response to the skin incision was classified as negative if no such movement occurred within 1 min after the skin incision.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Pregabalin on the Minimum Alveolar Concentration of Sevoflurane: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

et al. 2022

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BackgroundPregabalin is commonly used perioperatively to reduce post-operative pain and opioid consumption and to prevent the development of chronic pain. It has been shown to reduce anesthetic consumption in balanced anesthesia, but studies investigating its effect on the minimum alveolar concentration (MAC) of volatile anesthetics are lacking. The aim of this study was to investigate the effect of two different doses of pregabalin on the MAC of sevoflurane.MethodsIn a randomized, double-blinded, placebo controlled clinical study, 75 patients were assigned to receive placebo, 300 mg pregabalin, or 150 mg pregabalin, as a capsule 1 h before anesthesia induction with sevoflurane only. After equilibration, the response to skin incision (movement vs. non-movement) was monitored. The MAC was assessed using an up- and down-titration method.ResultsThe MAC of sevoflurane was estimated as 2.16% (95% CI, 2.07–2.32%) in the placebo group, 1.44% (95% CI, 1.26–1.70%) in the 300 mg pregabalin group, and 1.81% (95% CI, 1.49–2.13%) in the 150 mg pregabalin group. We therefore report a 33% reduction in the MAC of sevoflurane in the 300 mg pregabalin group as compared to placebo. The MAC of the 150 mg pregabalin group was reduced by 16% as compared to placebo but was not statistically significant.ConclusionsThe administration of 300 mg pregabalin reduced the MAC of sevoflurane by 33%, while the administration of 150 mg pregabalin did not significantly reduce the MAC of sevoflurane. Pregabalin use led to a small reduction in post-operative pain levels but increased side effects in a dose-dependent manner.

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“…However, some research has suggested that the acute psychoactive effects, including the dissociative, psychotomimetic, and 'mystical' effects, experienced during or shortly after a sub-anesthetic dosage of ketamine administration, may be associated with its therapeutic benefits. Esketamine has twice the analgesic effect of racemic ketamine, has fewer side effects, such as hallucinations, results in a faster recovery, and is able to lower the sevoflurane MAC value (19). Esketamine also has sympathomimetic properties that cause less cardiorespiratory depression than other sedatives, which had been reported that propofol combined with esketamine exhibited a good safety profile and high reliability, was more conducive to the hemodynamics stability, alleviating surgical stress and inflammatory responses (20).…”

Section: Immunofluorescence Detection and Western Blotmentioning

confidence: 99%

Effects of different dosages esketamine on cardiac conduction and heterogeneity of Cx43: the epicardial mapping in guinea pigs

Cao¹,

Song²,

Wang³

et al. 2022

Ann Transl Med

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Background: Esketamine is favored in clinical settings. Relative to other anesthetics it preserves protective airway reflexes, maintains spontaneous respiration, stabilizes hemodynamics, and alleviates neuropathic pain.This study sought to evaluate the cardiac safety of esketamine at 3 sub-anesthetic gradient concentrations. Methods:We examined the cardiac electrophysiological effects of esketamine with infusion rates of 0.125, 0.25, and 0.5 mg•kg -1 •h -1 . Short-term studies were performed in ventricular myocytes using patchclamp techniques and optically mapped Langendorff-perfused guinea-pig hearts. Long-term studies were performed using Langendorff-perfused guinea-pig hearts and electrically mapping the receipt of the infusion for 3 hours. Results: Esketamine changed the action potential (AP) morphology of cardiomyocytes. Notably, it increased the resting membrane potential (RMP), attenuated the amplitude of action potential (APA), reduced the maximum upstroke velocity (Vmax), and shortened the action potential duration (APD) at 30% to 70%, which led to relatively prolonged monophasic action potentials (MAP) triangulation in G 0.25 and G 0.5 . All the effects were partially eluted. Optical mapping demonstrated almost equal and heterogeneous conduction. G 0.125 resulted in an increased heart rate (HR) accompanied by a shortened APD. No detectable arrhythmia was observed at the cycle lengths (CLs) used. Long-term electrical mapping demonstrated the dose-dependent deceleration of the Vmax and APA, but only prolonged the AP parameters in G 0.5 . Leftventricular isochronal conduction maps revealed the conduction heterogeneities at G 0.5 , and conduction velocity (CV) was increased in G 0.125 and G 0.25. None of these effects were reversed on drug washout. Electrocardiogram (ECG) traces revealed an accelerated HR with the associated curtailment of QT intervals in G 0.125 ; HRs were decreased in G 0.25 and G 0.5 ; the PR intervals and QRS duration differed between G 0.125 and G 0.25 , G 0.5 , which elicited electrical alternans. Connexin43 (Cx43) expression were significantly decreased in G 0.125 , G 0.25 and G 0.5 . Conclusions: These data provide a basic electrophysiology for esketamine. Specifically, we found that (I) various methods of esketamine infusion had different effects on cardiac conduction at different dosages; (II) the heterogeneous expression of Cx43 is associated with spatially dispersed conduction; and (III) potential

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Effect of intravenous S-ketamine on the MAC of sevoflurane: a randomised, placebo-controlled, double-blinded clinical trial

Cited by 25 publications

References 29 publications

Perioperative Intravenous Low-Dose Ketamine Infusion to Minimize Pain for Septorhinoplasty: A Prospective, Randomized, Double-Blind Study

Perioperative Intravenous Low-Dose Ketamine Infusion to Minimize Pain for Septorhinoplasty: A Prospective, Randomized, Double-Blind Study

The Effect of Pregabalin on the Minimum Alveolar Concentration of Sevoflurane: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Effects of different dosages esketamine on cardiac conduction and heterogeneity of Cx43: the epicardial mapping in guinea pigs

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