Prospective evaluation of adjunctive ketamine on sphincter of Oddi motility in humans

Varadarajulu, Shyam; Tamhane, Ashutosh; Wilcox, C. Mel

doi:10.1111/j.1440-1746.2007.05024.x

Cited by 17 publications

(4 citation statements)

References 25 publications

(74 reference statements)

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“…However, a recent study by Varadarajulu et al showed that there were no significant changes in flow resistance of the sphincter of Oddi in humans receiving ketamine for sedation [7].…”

Section: Discussionmentioning

confidence: 98%

Chronic Ketamine Abuse Associated with Cholestasis and Cholangitis: A Case Report

Poh

Ho²,

Zainuddin³

2012

UIJ

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Ketamine is an anesthetic drug that has been used in clinical settings since the 1960s. Unfortunately, this medication has been abused as a recreational drug among partygoers and youth over the last 30 years. Recently, mounting of evidence has shown the association between chronic ketamine abuse and urinary tract complications. However, not many are aware that chronic ketamine abuse may also be responsible for cholestasis and cholangitis. We report a case of urinary tract complication from chronic ketamine abuse in combination with cholestasis, cholangitis, and early liver cirrhosis related to the drug. Public awareness about ketamine abuse and its complications should be communicated. Physicians should have a high index of suspicion for ketamine abuse in someone presenting with lower urinary tract symptoms along with jaundice, abdominal pain, and abnormal liver function.rectal examination and other systemic examinations were unremarkable. His urine analysis showed the presence of leukocytes and a mild trace of blood.An ultrasound of the abdomen showed bilateral mild to moderate hydronephrosis and hydroureter with no evidence of urinary stones. Cystoscopy examination revealed features of urethritis and cystitis. Renal computed tomography (CT) showed features of right pyelonephritis and bilateral obstructive uropathy, with no apparent cause identified (Figure 1). On the CT scan, there was mild intrahepatic duct dilation with no apparent distal obstruction. The renal profile was mildly deranged (urea: 14.1 mmol/L; sodium: 129 mmol/L; potassium: 3.2 mmol/L; creatinine: 136 µmol/L).The patient was treated for urosepsis with bilateral obstructive uropathy. Intravenous antibiotics were started, and his condition initially improved. Since the patient also had elevated alkaline phosphatase (ALP: 1032u/L) and total bilirubin (TB: 51 µmol/L), he was referred to the hepatology team for further investigation, but the patient refused.

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“…However, a recent study by Varadarajulu et al showed that there were no significant changes in flow resistance of the sphincter of Oddi in humans receiving ketamine for sedation [7].…”

Section: Discussionmentioning

confidence: 98%

Chronic Ketamine Abuse Associated with Cholestasis and Cholangitis: A Case Report

Poh

Ho²,

Zainuddin³

2012

UIJ

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“…suggests that ketamine stimulates opiate receptors and is associated with an increase in flow resistance through the sphincter of Oddi [ 45 ]. On the contrary, the results of sphincter of Oddi manometry in human subjects receiving low-dose ketamine for endoscopy does not support this claim [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Features of biliary tract diseases in ketamine abusers: a systematic review of case reports

Teymouri,

Nasoori,

Fakheri

et al. 2024

J Med Case Reports

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Background and aims Anesthesiologists prefer ketamine for certain surgeries due to its effectiveness as a non-competitive inhibitor of the N-methyl-D-aspartate receptor in the brain. Recently, this agent has also shown promise as an antidepressant. However, ketamine can cause hallucinogenic effects and is sometimes abused as an illicit drug. Ketamine abuse has been associated with liver and bile duct complications. This systematic study aims to better understand cholangiopathy in ketamine abusers by reviewing case reports. Methods and material In this systematic review, a comprehensive literature search was conducted with the terms “biliary tract diseases” and “ketamine”. Case reports and case series of adult patients with documented ketamine abuse and reported cholangiopathy or biliary tract disease were included. We extracted the data of relevant information and the results were reported through narrative synthesis and descriptive statistics. Results A total of 48 studies were initially identified, and 11 studies were finally included in the review. The mean age of the patients was 25.88 years. Of the 17 patients, 64.7% were men. Symptoms often included abdominal pain, nausea, and vomiting. Most patients were discharged with improved symptoms and liver function. Common bile duct dilation and other findings were observed in imaging results and other diagnostic studies. Conclusion This review highlights the diverse presentations and diagnostic modalities used in ketamine-induced cholangiography. These patients tend to be young men with deranged liver function tests and abdominal pain, which should be taken into consideration. These patients often require a multidisciplinary approach in their management.

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“…In a prospective investigation of patients receiving ketamine for sedation during endoscopic retrograde cholangiopancreatography, the authors were unable to visualise any change in pressures or motility of the sphincter of Oddi post ketamine use and there was no SSC, 8 further indicating that, in the bolus doses used, ketamine is a safe drug to use for sedation purposes.…”

mentioning

confidence: 99%

Reply to: Ketamine-based analgosedation for dressing changes in burn patients

Swami

McClune

Black

et al. 2022

European Journal of Anaesthesiology

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Prospective evaluation of adjunctive ketamine on sphincter of Oddi motility in humans

Abstract: Ketamine at 20 mg did not significantly affect SOM parameters. Further studies are required to confirm our preliminary findings before ketamine can be added to the armamentarium of agents used for performance of sphincter of Oddi manometry.

Cited by 17 publications

References 25 publications

Chronic Ketamine Abuse Associated with Cholestasis and Cholangitis: A Case Report

Chronic Ketamine Abuse Associated with Cholestasis and Cholangitis: A Case Report

Features of biliary tract diseases in ketamine abusers: a systematic review of case reports

Reply to: Ketamine-based analgosedation for dressing changes in burn patients

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