Perspectives on adjunctive use of ketamine for analgosedation during extracorporeal membrane oxygenation

Maybauer, Marc O.; Koerner, Michael M.; Maybauer, Dirk M.

doi:10.1080/17425255.2019.1593963

Cited by 3 publications

(2 citation statements)

References 13 publications

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“…Two recent case studies and one review suggest that ketamine infusion can be used as an analgesic for ECMO patients, reducing sedatives and opioid doses without changing the Richmond Agitation and Sedation Scale (RASS) score[ 19 - 21 ]. Based on the above findings, ketamine combined with local lidocaine infiltration may be an option for analgesia in ECMO patients during the establishment of extracorporeal circulation.…”

Section: Management Of Pain Caused By the Establishment Of Vascular A...mentioning

confidence: 99%

Management of procedural pain in the intensive care unit

Guo¹,

Wang²,

Zhao³

et al. 2022

WJCC

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Pain is a common experience for inpatients, and intensive care unit (ICU) patients undergo more pain than other departmental patients, with an incidence of 50% at rest and up to 80% during common care procedures. At present, the management of persistent pain in ICU patients has attracted considerable attention, and there are many related clinical studies and guidelines. However, the management of transient pain caused by certain ICU procedures has not received sufficient attention. We reviewed the different management strategies for procedural pain in the ICU and reached a conclusion. Pain management is a process of continuous quality improvement that requires multidisciplinary team cooperation, pain-related training of all relevant personnel, effective relief of all kinds of pain, and improvement of patients' quality of life. In clinical work, which involves complex and diverse patients, we should pay attention to the following points for procedural pain: (1) Consider not only the patient's persistent pain but also his or her procedural pain; (2) Conduct multimodal pain management; (3) Provide combined sedation on the basis of pain management; and (4) Perform individualized pain management. Until now, the pain management of procedural pain in the ICU has not attracted extensive attention. Therefore, we expect additional studies to solve the existing problems of procedural pain management in the ICU.

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Section: Management Of Pain Caused By the Establishment Of Vascular A...mentioning

confidence: 99%

Management of procedural pain in the intensive care unit

Guo¹,

Wang²,

Zhao³

et al. 2022

WJCC

View full text Add to dashboard Cite

show abstract

“…Among the opioids, fentanyl and morphine have been reported as the most frequently administered while among sedatives, midazolam and propofol have been suggested [57]. For ECMO patients requiring high dose of opioids and sedatives during ECMO support, ketamine has been suggested as a viable alternative [58].…”

Section: Analgesia and Sedationmentioning

confidence: 99%

Cardiac intensive care management of high-risk percutaneous coronary intervention using the venoarterial ECMO support

Zuin

Rigatelli²

2019

Heart Fail Rev

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The emerging concept of high-risk percutaneous coronary intervention (HR-PCI) has required the adoption of a multidisciplinary team approach. Venoarterial ECMO (VA-ECMO) has been introduced as a temporary mechanical circulatory support (MCS) for HR-PCI patients in order to provide an adequate systemic perfusion during the procedure. Both patient's complexity and technological evolutions have catalyzed the development of critical care cardiology; however, ECMO therapy faces several challenges. Indeed, the management of patients on ECMO remains complex; moreover, the lack of specific recommendation for HR-PCI patients further complicates the management of these patients. In this narrative review, we give a reappraisal for the management of HR-PCI patients supported with VA-ECMO according to the available data published in current literature.

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Extraction of ketamine and dexmedetomidine by extracorporeal life support circuits

Chevalier,

Porter Hunt,

Whelan

et al. 2024

J Extra Corpor Technol

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Background: Patients supported with extracorporeal life support (ECLS) circuits such as ECMO and CRRT often require high doses of sedatives and analgesics, including ketamine and dexmedetomidine. Concentrations of many medications are affected by ECLS circuits through adsorption to the circuit components, dialysis, as well as the large volume of blood used to prime the circuits. However, the impact of ECLS circuits on ketamine and dexmedetomidine pharmacokinetics has not been well described. This study determined ketamine and dexmedetomidine extraction by extracorporeal circuits in an ex-vivo system. Methods: Medication was administered at therapeutic concentration to blood-primed, closed-loop ex-vivo ECMO and CRRT circuits. Drug concentrations were measured in plasma, hemofiltrate, and control samples at multiple time points throughout the experiments. At each sample time point, the percentage of drug recovery was calculated. Results: Ketamine plasma concentration in the ECMO and CRRT circuits decreased rapidly, with 43.8% recovery (SD = 0.6%) from ECMO circuits after 8 h and 3.3% (SD = 1.8%) recovery from CRRT circuits after 6 h. Dexmedetomidine was also cleared from CRRT circuits, with 20.3% recovery (SD = 1.8%) after 6 h. Concentrations of both medications were very stable in the control experiments, with approximately 100% drug recovery of both ketamine and dexmedetomidine after 6 h. Conclusion: Ketamine and dexmedetomidine concentrations are significantly affected by ECLS circuits, indicating that dosing adjustments are needed for patients supported with ECMO and CRRT.

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Perspectives on adjunctive use of ketamine for analgosedation during extracorporeal membrane oxygenation

Cited by 3 publications

References 13 publications

Management of procedural pain in the intensive care unit

Management of procedural pain in the intensive care unit

Cardiac intensive care management of high-risk percutaneous coronary intervention using the venoarterial ECMO support

Extraction of ketamine and dexmedetomidine by extracorporeal life support circuits

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