Ketamine and propofol in combination for adult procedural sedation and analgesia in the emergency department

Mah, Greg T; Turgeon, Ricky D.; Loh, Gabriel; Tejani, Aaron M; Sweet, David

doi:10.1002/14651858.cd011456

Cited by 1 publication

(2 citation statements)

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“…Esketamine, a right-handed split of ketamine, might be a potential substitute for opioids in ORA or OFA. Esketamine is a noncompetitive N-methyl-d-aspartate (NMDA)-receptor antagonist, and its anaesthetic effect is approximately twofold higher than that of racemic ketamine, with a lower incidence of psychotropic side effects at equivalent doses [12,13]. In addition, due to a ketamine-induced increase in sympathetic tone, esketamine results in less respiratory depression and hypotension than other anaesthetics and analgesics [14].…”

Section: Introductionmentioning

confidence: 99%

“…Esketamine is a noncompetitive N-methyl-d-aspartate (NMDA)-receptor antagonist, and its anaesthetic effect is approximately twofold higher than that of racemic ketamine, with a lower incidence of psychotropic side effects at equivalent doses [12,13]. In addition, due to a ketamine-induced increase in sympathetic tone, esketamine results in less respiratory depression and hypotension than other anaesthetics and analgesics [14]. Studies also report that esketamine creates less impairment in concentration capacity and primary memory and fewer cardiopulmonary adverse effects and may lead to a faster recovery [15,16].…”

Section: Introductionmentioning

confidence: 99%

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Esketamine-based opioid-free anaesthesia alleviates postoperative nausea and vomiting in patients who underwent laparoscopic surgery: study protocol for a randomized, double-blinded, multicentre trial

Chen

Meng

Gao

et al. 2023

Trials

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Background Although opioids are commonly prescribed in clinical anaesthesia, the significant side effects attributed to their overuse are raising increasing concerns. One way to reduce perioperative opioid consumption is to apply opioid-reduced anaesthesia (ORA) and even opioid-free anaesthesia (OFA), which involves regional techniques, neuraxial anaesthesia, nonopioid analgesics or combined use. The aim of this study was to investigate whether the application of OFA by using esketamine in intraoperative analgesia could minimize the side effects of postoperative nausea and vomiting (PONV), as well as other short-term side effects related to anaesthesia. Methods/design The study was designed as a prospective, randomized, controlled, multicentre trial. A total of 278 patients were enrolled; participants were nonsmoking female patients aged 18–50 years and scheduled for laparoscopic appendectomy or cholecystectomy, ASA at I–III, with no serious physical or mental diseases. Both groups received usual perioperative care except for the analgesic medication of either esketamine or sufentanil. The primary outcome was the incidence of PONV 3 days after surgery. Secondary outcomes included recovery status, pain, sedation level and overall recovery, delirium and cognition, anxiety and depression and total consumption of analgesic agents. Discussion This trial may show that the synergy of esketamine and propofol anaesthesia reduces PONV as well as other short-term adverse events, thereby providing a better safety and satisfaction profile of ERAS for laparoscopic appendectomy and cholecystectomy. Trial registration Chinese Clinical Trial Registry ChiCTR2100047169. Registered on June 9, 2021

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Section: Introductionmentioning

confidence: 99%