Prophylactic use of ketamine reduces postpartum depression in Chinese women undergoing cesarean section✰

Ma, Jiahui; Wang, Sai-Ying; Yu, He-Ya; Li, Danyang; Luo, Shi-Chao; Zheng, Shanshan; Wan, Lifei; Duan, Kai-Ming

doi:10.1016/j.psychres.2019.03.026

Cited by 69 publications

(74 citation statements)

References 46 publications

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“…These factors make the prevention of postoperative depression increasingly difficult. Ma et al and Zhou et al reported that 0.5 mg/kg of (R,S)-ketamine can reduce postpartum depression after cesarean section (Zhou and Gan, 2017;Ma et al, 2019), while Lv and Liu et al reported that 0.25 mg/kg of (R,S)-ketamine can prevent postpartum depression after cesarean delivery (Liu and Zhang, 2013;L, 2015). However, Xu et al found that 0.25 mg/kg of (R,S)ketamine did not prevent postpartum depression .…”

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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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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“…Три РКИ, включенных в обзор, посвящены изучению эффективности малых доз кетамина в предупреждении развития послеродовой депрессии (ПРД) [31,35,40]. Y. Xu и соавт., изучая уровень послеродовой депрессии в течение 6 нед., не выявили влияния интраоперационного введения 0,25 мг/кг кетамина на послеродовую депрессию в течение 6 нед.…”

Section: Discussionunclassified

“…[29] вводили 30 мг кетамина всем пациенткам. В двух исследованиях кетамин вводился и болюсно, и в виде продленной инфузии [30,31]. В двух исследованиях сравнивались клинические эффекты двух разных доз кетамина 0,25 мг/кг и 0,5 мг/кг [3,32].…”

Section: описания рки включенные в анализunclassified

“…В двенадцати исследованиях [9, 28-30, 32-34, 36-40] в том или ином аспекте изучалось влияние низких доз кетамина на выраженность послеоперационной боли, в трех [31,35,40] исследованиях анализировалась связь внутривенного введения кетамина и послеродовой депрессии, две работы [3,4] были посвящены профилактике дрожи/озноба после выполнения СА, два РКИ [7,8] выявляли влияние низких доз кетамина на выраженность ПОТР, одно [9] -на частоту ППГБ.…”

Section: описания рки включенные в анализunclassified

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Clinical effects of low-dose intravenous ketamine in obstetrics: a systematic review

Shindyapina

Marshalov

Shifman³

et al. 2020

Annals of Critical Care

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Introduction. Over the past decade, there has been increased attention to ketamine, which is associated with the identification of its new effects when using low (less than 1 mg/kg for bolus administration and less than 20 μg/kg/min for prolonged infusion) doses of the drug. In pregnant women, the pharmacokinetics of most drugs change, so the results of studies of low doses of ketamine obtained in other categories of patients may not be reproduced in the obstetric population. Objectives. Assessment of the clinical effects of various doses and regimens of ketamine administration, within the subanesthetic range, in the perioperative period of cesarean section. Material and Methods. Publications were searched in the electronic databases PubMed, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) by four reviewers independently. The date of the last search query was December 31, 2019. Results. A total of 18 randomized controlled trials (RCTs) involving 2703 patients were included in the review. The results of this systematic review showed that the administration of low doses of ketamine (in the range of 0.15-0.5 mg/kg) in the perioperative period of cesarean section performed under spinal anesthesia can reduce the intensity of pain and the need for analgesics in the postoperative period. The use of low doses of ketamine under these conditions can also be useful to reduce the severity of chills, itching, and the prevention of postoperative nausea and vomiting, post-puncture headache, and postpartum depression. Doses of less than 0.5 mg/kg appear to be safer and comparatively effective in the prevention of the above complications. However, the small number and high heterogeneity of research does not allow us to draw unambiguous conclusions. The effectiveness of low doses of ketamine in the prevention of these complications with general anesthesia also remains unclear. Conclusion. Further research and a meta-analysis of the data are necessary to obtain final conclusions.

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“…It has a wide therapeutic range and is safely used as an anesthetic for patients in all age groups and for a variety surgical procedures [11,12]. In addition, recent research on ketamine as prophylaxis for postpartum depression [13,14] has created interest in the question of ketamine excretion in breastmilk, and a pharmacodynamic study in breastfeeding women is underway (ClinicalTrials.gov identifier: NCT04285684).…”

Section: Introductionmentioning

confidence: 99%

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

Gilder

Tun

Carter

et al. 2021

BMC Pregnancy Childbirth

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Background Anesthesia in lactating women is frequently indicated for time-sensitive procedures such as postpartum tubal ligation. Ketamine and diazepam are two of the most commonly used anesthetic agents in low resource settings, but their safety profile in lactating women has not been established. Methods Medical records of post-partum tubal ligations between 2013 and 2018 at clinics of the Shoklo Malaria Research Unit were reviewed for completeness of key outcome variables. Logistic regression identified presence or absence of associations between drug doses and adverse neonatal outcomes: clinically significant weight loss (≥95th percentile) and neonatal hyperbilirubinemia requiring phototherapy. Results Of 358 records reviewed, 298 were lactating women with singleton, term neonates. There were no severe outcomes in mothers or neonates. On the first postoperative day 98.0% (290/296) of neonates were reported to be breastfeeding well and 6.4% (19/298) had clinically significant weight loss. Phototherapy was required for 13.8% (41/298) of neonates. There was no association between either of the outcomes and increasing ketamine doses (up to 3.8 mg/kg), preoperative oral diazepam (5 mg), or increasing lidocaine doses (up to 200 mg). Preoperative oral diazepam resulted in lower doses of intraoperative anesthetics. Doses of intravenous diazepam above 0.1 mg/kg were associated with increased risk (adjusted odds ratio per 0.1 mg/kg increase, 95%CI) of weight loss (1.95, 95%CI 1.13–3.35, p = 0.016) and jaundice requiring phototherapy (1.87, 95%CI 1.11–3.13, p = 0.017). Conclusions In resource-limited settings ketamine use appears safe in lactating women and uninterrupted breastfeeding should be encouraged and supported. Preoperative oral diazepam may help reduce intraoperative anesthetic doses, but intravenous diazepam should be used with caution and avoided in high doses in lactating women.

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Prophylactic use of ketamine reduces postpartum depression in Chinese women undergoing cesarean section✰

Cited by 69 publications

References 46 publications

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

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

Clinical effects of low-dose intravenous ketamine in obstetrics: a systematic review

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting

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