Effects of a single subanaesthetic dose of ketamine on pain and mood after laparoscopic bariatric surgery

Wang, Jing; Echevarría, Ghislaine C.; Doan, Lisa; Ekasumara, Nydia; Calvino, Steven; Chae, Floria; Martinez, Erik; Robinson, Eric; Cuff, Germaine; Franco, Lola; Muntyan, Igor; Kurian, Marina; Schwack, Bradley; Bedrosian, Andrea S.; Fielding, George; Ren-Fielding, Christine

doi:10.1097/eja.0000000000000860

Cited by 35 publications

(34 citation statements)

References 63 publications

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“…e incidence of adverse events was reported to be very low and mild with low-dose ketamine [22,29]. In our study, we reported most of these side effects, in addition to sedation, all of which were self-limiting requiring minimal interference in the form of verbal reassurance and midazolam increments and this goes with other studies [13,24]. In Dalsasso and their colleagues' study [23], they reported that clonidine and midazolam administration during anesthesia appeared to minimize the cardiovascular and psychotomimetic effects of ketamine.…”

Section: Discussionsupporting

confidence: 86%

“…In another study done by Wang and their colleagues [13], they hypothesized that 0.4 mg/kg of ketamine over 20 minutes after laparoscopic bariatric surgery can improve pain and mood scores in the immediate postoperative period. ey performed their study on 100 morbidly obese patients on which they assessed their mood by Beck Depression Inventory (BDI) and Montgomery-Asberg ese results also suggest that ketamine may be able to improve postoperative mood.…”

Section: Discussionmentioning

confidence: 99%

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Acute Effects of Ketamine Infusion on Postoperative Mood Scores in Patients Undergoing Dilation and Curettage: A Randomized Double-Blind Controlled Study

Mostafa

Khamis

Saleh

et al. 2021

Anesthesiology Research and Practice

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Background. Emotional and psychological effects following abortion are more common than physical side effects and can range from mild regret to more serious complications such as depression. In the last decade, it has been suggested that low dose of ketamine is a fast-acting antidepressant. Purpose. The aim of this study was to investigate the impact of intraoperative ketamine infusion on postoperative mood score in patients undergoing Dilation and Curettage (D&C) under spinal anesthesia. We hypothesized that a single low-dose administration of ketamine infusion during D&C surgery can improve mood scores in the immediate postoperative period. Methods. A prospective, randomized, double-blind, parallel-group, placebo-controlled trial. The study included a total of 60 patients, ≥18 years, physical status ASA II, with up to 12-week gestation undergoing elective D&C surgery. Patients were divided randomly into a ketamine group (group K) and a control group (group C). In group K, 0.4 mg/kg ketamine was given as a continuous infusion over 20 min intraoperatively. Main Outcome Measure. Profile of Mood States (POMS) was recorded preoperatively and 2 hours postoperatively. Results. There were no differences in preoperative POMS between the two groups. Mean postoperative POMS of group K was lower than that of group C indicating mood improvement. Ketamine group patients showed higher sedation score and increased, although self-limiting, psychedelic phenomena than the control group. Conclusion. Observed data here support an acute effect of ketamine on mood but any further claim will be speculative. Further future studies exploring postoperative mood scores after 24 hours post-infusion are needed. This trial is registered with PACTR201907779292947.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Acute Effects of Ketamine Infusion on Postoperative Mood Scores in Patients Undergoing Dilation and Curettage: A Randomized Double-Blind Controlled Study

Mostafa

Khamis

Saleh

et al. 2021

Anesthesiology Research and Practice

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“…Similarly, Jiang et al found that 0.5 mg/kg of (R,S)-ketamine during surgery reduces postoperative depression scores and elevates serum BDNF levels, indicating that (R,S)ketamine may alleviate postoperative depression by increasing BDNF expression . Wang et al found that a single dose of (R,S)-ketamine (0.4 mg/kg) administered immediately after surgery reduces the SF-MPQ score (Wang et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: Postoperative depression is a common complication after surgery that profoundly affects recovery and prognosis. New research indicates that (R,S)-ketamine is a potent antidepressant that exerts a rapid and sustained antidepressive effect. However, there is no consensus on whether intraoperative low-dose (R,S)-ketamine prevents postoperative depression. Objectives: This study aimed to investigate the safety, feasibility, and short-term complications of intraoperative low-dose (R,S)-ketamine in preventing postoperative depressive symptoms. Methods: The Web of Science, Cochrane, PubMed, and CNKI databases were systematically searched (last search February 28, 2020) to identify studies involving ketamine. Sensitivity and metaregression analyses were performed to identify potential confounders. The meta-analysis was performed using Review Manager 5.3. Results: A total of 13 studies (seven in Chinese and six in English) representing 1,148 cases of patients who were treated with (R,S)-ketamine and 874 cases of patients who received other treatments were included in the meta-analysis. Anesthesia duration and blood loss did not significantly differ between the two groups, demonstrating that (R,S

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“…A recent Cochrane meta-analysis review concluded that perioperative intravenous KET reduces post-operative pain and nausea and analgesic consumption ( Brinck et al, 2017 ); however, not all studies are consistent with these findings. In a recent randomized controlled study (RCT) on 100 obese patients, of whom 22 with history of depression and 13 with history of chronic pain, undergoing laparoscopic gastric bypass or gastrectomy, post-operative infusion of KET (0.4 mg/kg, ideal body weight) was not superior to placebo on post-operative pain and mood assessed with a pain Visual Analogue Scale, the Beck Depression Inventory and the Montgomery–Asberg Depression Rating Scale; KET, however, improved the affective and the total score of the short-form McGill Pain Questionnaire starting on post-operative day 2 ( Wang et al, 2019 ). In the PODCAST multicenter RCT on 672 older adults (i.e., >60 years) undergoing cardiac and non-cardiac surgery, pre-incisional KET (0.5 or 1 mg/kg) did not decrease post-operative pain, delirium, or depressed mood ( Avidan et al, 2017 ).…”

Section: Clinical Studiesmentioning

confidence: 99%

Analgesic and Antidepressant Effects of the Clinical Glutamate Modulators Acetyl-L-Carnitine and Ketamine

et al. 2021

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Pain and depression are leading causes of disability and of profound social and economic burden. Their impact is aggravated by their chronicity and comorbidity and the insufficient efficacy of current treatments. Morphological and functional metabolism studies link chronic pain and depressive disorders to dysfunctional neuroplastic changes in fronto-limbic brain regions that control emotional responses to painful injuries and stressful events. Glutamate modulators are emerging new therapies targeting dysfunctional brain areas implicated in the generation and maintenance of chronic pain and depression. Here, we report the effects of two clinically approved glutamate modulators: acetyl-L-carnitine (ALCAR) and S, R(±)ketamine (KET). ALCAR is a natural neurotrophic compound currently marketed for the treatment of neuropathies. KET is the prototypical non-competitive antagonist at N-methyl-D-aspartate glutamate receptors and a clinically approved anesthetic. Although they differ in pharmacological profiles, ALCAR and KET both modulate aminergic and glutamatergic neurotransmissions and pain and mood. We assessed in rats the effects of ALCAR and KET on cerebral metabolic rates for glucose (rCMRglc) and assessed clinically the effects of ALCAR in chronic pain and of KET in post-operative pain. ALCAR and KET increased rCMRglc at similar degrees in prefrontal, somatosensory, and cingulate cortices, and KET increased rCMRglc at a different, much larger, degree in limbic and dopaminergic areas. While rCMRglc increases in prefrontal cortical areas have been associated with analgesic and antidepressant effects of ALCAR and KET, the marked metabolic increases KET induces in limbic and dopaminergic areas have been related to its psychotomimetic and abuse properties. In patients with chronic neuropathic pain, ALCAR (1,000 mg/day) yielded to a fast (2 weeks) improvement of mood and then of pain and quality of life. In day-surgery patients, KET improved dischargeability and satisfaction. In obese patients undergoing bariatric surgery, a single, low dose of KET (0.5 mg/kg) at induction of anesthesia determined a very fast (hours) amelioration of post-operative depression and pain and an opioid-sparing effect. These findings indicate that ALCAR and KET, two non-selective glutamate modulators, still offer viable therapeutic options in comorbid pain and depression.

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Effects of a single subanaesthetic dose of ketamine on pain and mood after laparoscopic bariatric surgery

Cited by 35 publications

References 63 publications

Acute Effects of Ketamine Infusion on Postoperative Mood Scores in Patients Undergoing Dilation and Curettage: A Randomized Double-Blind Controlled Study

Acute Effects of Ketamine Infusion on Postoperative Mood Scores in Patients Undergoing Dilation and Curettage: A Randomized Double-Blind Controlled Study

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

Analgesic and Antidepressant Effects of the Clinical Glutamate Modulators Acetyl-L-Carnitine and Ketamine

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