Nebulized ketamine to avoid mechanical ventilation in a pediatric patient with severe asthma exacerbation

Elkoundi, Abdelghafour; Bentalha, Aziza; Koraichi, Alae El; Kettani, S.

doi:10.1016/j.ajem.2018.01.027

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…44 Ketamine has been investigated as a potential treatment for acute asthma attack and refractory status asthmaticus in part due to its sympathomimetic hemodynamic effects, analgesic and sedative effects, and bronchodilating properties. Ketamine has been shown to reduce the likelihood of intubation in children and adults suffering from acute asthma attacks 26,27,29,45 as well as alleviate lung injury by decreasing pro-inflammatory cytokines. [46][47][48][49] In addition to intravenous, inhalational administration of ketamine was shown to improve the peak expiratory flow rates (PEFR) in patients with acute severe asthma that had not responded well to traditional treatments.…”

Section: Discussionmentioning

confidence: 99%

Ketamine Attenuates Airway Inflammation via Inducing Inflammatory Cells Apoptosis and Activating Nrf2 Pathway in a Mixed-Granulocytic Murine Asthma Model

Xiao

Zhou

Wang

et al. 2022

DDDT

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The use of ketamine, an anesthetic, as a treatment for asthma has been investigated in numerous studies. However, how ketamine affects asthma is unclear. The present study examined the effects of ketamine on a murine model of mixed-granulocytic asthma, and the role of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. Methods: The murine model of mixed-granulocytic asthma was established using ovalbumin (OVA) for sensitization and the combination of OVA and lipopolysaccharides (LPS) for challenge. The main characteristics of asthma, oxidative stress biomarkers, and the expression of the Nrf2 pathway were examined. ML385 was administered to verify the role of the Nrf2 pathway. Results: Mice in the OVA +LPS group developed asthmatic characteristics, including airway hyperresponsiveness, mixedgranulocytic airway inflammation, mucus overproduction, as well as increased levels of oxidative stress and impaired apoptosis of inflammatory cells. Among the three concentrations, ketamine at 75mg/kg effectively attenuated these asthmatic symptoms, activated the Nrf2 pathway, decreased oxidative stress, and induced apoptosis of eosinophils and neutrophils in bronchoalveolar lavage fluid (BALF) with a reducing level of myeloid cell leukemia 1(Mcl-1). ML385 (an Nrf2 inhibitor) eliminated the protective effects of ketamine on the mixed-granulocytic asthma model. Conclusion:The study concluded that ketamine reduced oxidative stress and attenuated asthmatic symptoms (neutrophilic airway inflammation) by activating the Nrf2-Keap1 pathway, with 75 mg/kg ketamine showing the best results. Ketamine administration also increased neutrophil and eosinophil apoptosis in BALF, which may contribute to the resolution of inflammation. The use of ketamine as a treatment for asthma may therefore be beneficial.

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Section: Discussionmentioning

confidence: 99%

Ketamine Attenuates Airway Inflammation via Inducing Inflammatory Cells Apoptosis and Activating Nrf2 Pathway in a Mixed-Granulocytic Murine Asthma Model

Xiao

Zhou

Wang

et al. 2022

DDDT

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“…Evidence shows that inhalational ketamine is effective for the treatment of severe exacerbations of asthma. [66] It leads to improved outcomes and a reduction in the need for mechanical ventilation. It inhibits inflammatory cascade, reduces inflammatory markers, and causes bronchodilation.…”

Section: Anxiety Disordersmentioning

confidence: 99%

“…Systemic effects like anxiolysis and decrease in mechanical work of breathing also contribute to this effect. [66] In an RCT, i.v. ketamine in 0.4-0.5 mg/kg doses, followed by an infusion for 30 minutes produced a significant reduction in the peak expiratory flow rate (PEFR) among patients with mild-to-moderate bronchial asthma.…”

Section: Anxiety Disordersmentioning

confidence: 99%

Repurposing Potential of Ketamine: Opportunities and Challenges

Gautam¹,

Mahajan²,

Sharma³

et al. 2020

Indian Journal of Psychological Medicine

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Ketamine is a noncompetitive antagonist of the N-methyl-D-aspartate (NMDA) receptor which also interacts with various other receptors that account for its myriad actions. Originally approved as a general anesthetic, it is being explored to be repurposed for numerous other indications such as depressive disorders, suicidal ideation, substance-use disorders, anxiety disorders, chronic pain, refractory status epilepticus, and bronchial asthma exacerbations. Numerous trials are ongoing for the same. The nasal spray of esketamine, a more potent S (+) enantiomer of ketamine, has been approved by the United States Food and Drug Administration (USFDA) for treatment-resistant depression along with the oral antidepressants. However, there are concerns about its safety on long term use, given its psychedelic effects and potential abuse. In this review, we discuss repurposing ketamine for potential therapeutic use and about the safety concerns related to ketamine and esketamine.

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“…Sedasyonun şart olduğu hastalarda bronkodilatör etkisi de bilinen ketamin tercih edilmelidir. Hatta ağır astım ataklarrında nebül olarak ketamin uygulanmasının mekanik ventilasyon ihtiyacının azaltılmasına katkı sağladığını bildiren yeni bir çalışma da vardır (61).…”

Section: Aminofilinunclassified

Astim Alevlenmesi̇nde Kullanilan İlaçlar

Kılıç¹,

Doğru²

2020

Turkish Journal of Pediatric Disease

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orta alevlenmelerde başlangıç olarak 20 dakikada bir 4-10 puf ölçülü doz inhaler spacer ile sıklıkla hava yollarını açar (Kanıt A). Daha sonra ise 3-4 saatte bir 4-10 puf maksimum 1-2 saatte bir 6-10 puf geçilmeyecek şekilde devam ettirilebilir. Semptomlar kontrol altında ise ve yapabilen hastalarda PEF çocuğun en iyi değerinin %60-80'ine ulaşmışsa ek doza gerek yoktur (2). Beş yaş ve altı çocuklarda başlangıç dozu 2 puf salbutamol veya eşdeğeri olmalıdır ancak ağır alevlenmelerde 6 puf önerilir. Alevlenmenin ağırlığına göre salbutamol 2-6 puf 20 dakikada bir 1 saat içinde uygulanır (2). Başlangıç KEBA uygulaması ile semptomlar hızla düzelirse ve 1-2 saat içinde tekrarlama olmaz ise ileri tedavi gerekli değildir. 3-4 saat sonra tekrar KEBA verilebilir (24 saatte 10 pufa kadar) ve semptomlar 1 gün boyunca devam ederse İKS veya OKS gibi diğer tedaviler endikedir (Kanıt D) (2). Eğer semptomlar 1 saat içinde rahatlar ancak 3-4 saat içinde tekrarlarsa KEBA saatte bir 2-3 puf gibi daha sık verilebilir ve OKS uygulanabilir. 3-4 saat içinde 10 puf KEBA uygulanmasına rağmen hasta rahat değilse hastaneye refere edilmelidir (2). GİRİŞ Akut astım alevlenmeleri astım semptomlarında ve solunum fonksiyonlarında kötüleşme ataklarıdır. En yaygın kullanılan kısa etkili beta-2-agonist (KEBA) ilaçlar yanında ağır ve tedaviye yanıtsız astım alevlenmelerinde kullanılabilecek diğer tedavi seçenekleri de bulunmaktadır. Burada yeni literatürler eşliğinde zor olgular da dahil olmak üzere astım alevlenmelerinde kullanabileceğimiz ilaçlar ve yöntemler tartışılmıştır. Kısa Etkili Beta Agonist (KEBA) Astım alevlenmelerinin temel tedavisini bronkodilatör ilaçlar oluşturur. En etkin bronkodilatasyon sağlayan grup ise kısa etkili beta agonist (KEBA) ilaçlardır (1). Ülkemizde bu grupta kullandığımız ilaç ise salbutamoldür. Bir puf salbutamol 100 mcg etken madde içerir. Altı yaş ve üzeri çocuklardaki astım ataklarında/alevlenmelerinde, 2 puf KEBA (200 mcg salbutamol eşdeğeri) hemen uygulanıp gerekli oldukça 20 dakika ara ile iki kez daha uygulanır. Hafif ve

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Nebulized ketamine to avoid mechanical ventilation in a pediatric patient with severe asthma exacerbation

Cited by 8 publications

References 10 publications

Ketamine Attenuates Airway Inflammation via Inducing Inflammatory Cells Apoptosis and Activating Nrf2 Pathway in a Mixed-Granulocytic Murine Asthma Model

Ketamine Attenuates Airway Inflammation via Inducing Inflammatory Cells Apoptosis and Activating Nrf2 Pathway in a Mixed-Granulocytic Murine Asthma Model

Repurposing Potential of Ketamine: Opportunities and Challenges

Astim Alevlenmesi̇nde Kullanilan İlaçlar

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