Therapeutic Mechanisms of Ketamine

Mihaljević, Slobodan; Pavlović, Matko; Reiner, Krešimir; Čačić, Marko

doi:10.24869/psyd.2020.325

Cited by 40 publications

(31 citation statements)

References 81 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additional effects include bronchodilation, stimulation of the sympathetic nervous system, catalepsy and psychiatric effects, including rapid and sustained antidepressant activity. 1 – 4 Although these activities may be valuable in anaesthesia representing interesting advantages for special patient subgroups, such as those with respiratory or cardiovascular conditions, a possible psychotropic activity and other central effects have limited the use of ketamine as an anaesthetic in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

The multiple faces of ketamine in anaesthesia and analgesia

Natoli¹

2021

DIC

View full text Add to dashboard Cite

Objective Ketamine is an anaesthetic agent with a unique dissociative profile and pharmacological effects ranging from the induction and maintenance of anaesthesia to analgesia and sedation, depending on the dose. This article provides information for the clinical use of ketamine in anaesthesia, in both conventional and special circumstances. Methods This is a non-systematic review of the literature, through a PubMed search up to February 2021. Results With a favourable pharmacokinetic profile, ketamine is used in hospital and prehospital settings for emergency situations. It is suitable for patients with many heart conditions and, unlike other anaesthetics, its potential for cardiorespiratory depression is low. Furthermore, it may be used when venous access is difficult as it may be administered through various routes. Ketamine is the anaesthetic of choice for patients with bronchospasm thanks to its bronchodilatory and anti-inflammatory properties. Conclusion With a favourable pharmacokinetic profile, ketamine is used in hospital and prehospital settings for emergency situations and is suitable for patients with many cardiac and respiratory conditions.

show abstract

Section: Introductionmentioning

confidence: 99%

The multiple faces of ketamine in anaesthesia and analgesia

Natoli¹

2021

DIC

View full text Add to dashboard Cite

show abstract

“…Psychoactive effects were the main concern for esketamine or ketamine in anesthesia ( 20 ). Because ketamine and midazolam had similar half-life time for pharmacokinetics ( 21 , 22 ), they are usually combined in animal and human anesthesia to decrease psychoactive effects and improve the quality of anesthesia ( 12 , 13 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Midazolam Attenuates Esketamine-Induced Overactive Behaviors in Mice Before the Sedation, but Not During the Recovery

et al. 2022

View full text Add to dashboard Cite

Esketamine showed more potency, more rapid recovery from anesthesia, and less psychotomimetic side effects when compared with ketamine. However, the patients still experience psychotomimetic side effects of esketamine. In order to investigate whether midazolam can attenuate the esketamine-induced overactive behaviors and neuronal hyperactivities, midazolam 0, 40, 80, and 120 mg/kg combined with esketamine 50 mg/kg were administrated on Kunming mice to assess the behaviors changes during anesthesia. The indicators, including action time, duration of agitation before the sedation, duration of sedation, duration of loss of pedal withdrawal reaction (PWR), duration of loss of righting reaction (RR), duration of agitation during the recovery, and recovery time, were monitored for up to 3–4 h after intraperitoneal administration. The results demonstrated that midazolam 40, 80, and 120 mg/kg efficiently decreased the esketamine-induced overactive behaviors including ataxia, excitation, and catalepsy before sedation. Midazolam and esketamine synergically improved the anesthesia quality assessed by PWR and RR. However, even high doses of midazolam were not able to suppress the esketamine-induced psychotomimetic effects during the recovery.

show abstract

“…Therefore, ketamine may improve lung compliance and reduce airways resistances when administered as a continuous infusion. Moreover, it may increase bronchial secretions which may relieve mucus plugs [ 20 ]. Suggested dosages have been in the range of 0.5 to 2 mg/kg/h [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies

Via

Sanfilippo

Cuttone

et al. 2022

Eur J Clin Pharmacol

View full text Add to dashboard Cite

Purpose Asthma is a heterogeneous disease with a wide range of symptoms. Severe asthma exacerbations (SAEs) are characterized by worsening symptoms and bronchospasm requiring emergency department visits. In addition to conventional strategies for SAEs (inhaled β-agonists, anticholinergics, and systemic corticosteroids), another pharmacological option is represented by ketamine. We performed a systematic review to explore the role of ketamine in refractory SAEs. Methods We performed a systematic search on PubMed and EMBASE up to August 12th, 2021. We selected prospective studies only, and outcomes of interest were oxygenation/respiratory parameters, clinical status, need for invasive ventilation and effects on weaning. Results We included a total of seven studies, five being randomized controlled trials (RCTs, population range 44–92 patients). The two small prospective studies (n = 10 and n = 11) did not have a control group. Four studies focused on adults, and three enrolled a pediatric population. We found a large heterogeneity regarding sample size, age and gender distribution, inclusion criteria (different severity scores, if any) and ketamine dosing (bolus and/or continuous infusion). Of the five RCTs, three compared ketamine to placebo, while one used fentanyl and the other aminophylline. The outcomes evaluated by the included studies were highly variable. Despite paucity of data and large heterogeneity, an overview of the included studies suggests absence of clear benefit produced by ketamine in patients with refractory SAE, and some signals towards side effects. Conclusion Our systematic review does not support the use of ketamine in refractory SAE. A limited number of prospective studies with large heterogeneity was found. Well-designed multicenter RCTs are desirable.

show abstract

Therapeutic Mechanisms of Ketamine

Cited by 40 publications

References 81 publications

The multiple faces of ketamine in anaesthesia and analgesia

The multiple faces of ketamine in anaesthesia and analgesia

Midazolam Attenuates Esketamine-Induced Overactive Behaviors in Mice Before the Sedation, but Not During the Recovery

Use of ketamine in patients with refractory severe asthma exacerbations: systematic review of prospective studies

Contact Info

Product

Resources

About