• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.726-731
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• 2006

Purpose : We reported previously that intramuscular ketamine with adjunctive midazolam is more effective than ketamine alone in pediatric procedural sedation, but with limited satisfactory sedation by suboptimal ketamine dose. The optimal dose of intramuscular ketamine in children has never been studied in Korea. In this study, we investigated the effectiveness and adverse events of ketamine 4mg/kg with adjunctive midazolam in pediatric laceration repair. Methods : From Jan. 2005 to July 2005, we enrolled 60 children, aged 3 months-7 years, who needed laceration repair under sedation. After verbal consent from parents, patients were randomly assigned to KMA group(IM ketamine 4 mg/kg＋atropine 0.01 mg/kg＋intramuscular midazolam 0.05 mg/kg) or KA group(without midazolam). We compared both groups with the induction time, recovery time, total sedation time, efficacy of sedation, adverse effects, and the satisfaction score of treating physicians. Results : Potentially confounding variables, age, weight, injury site and anxiety score, were similar between groups. The induction time, recovery time and total sedation time were not different statistically. In KMA group, 90.9 percent of patients showed satisfactory sedation compared to 66.7 percent of KA group(P=0.02) and the occurrence rate of significant adverse effect was 0.0 percent and 37.0 percent respectively. Conclusion : We found adjunctive midazolam with ketamine doses of 4 mg/kg IM produced more effective, satisfactory sedation and less adverse effect than without midazolam in pediatric laceration repair. The emergence phenomenon(agitation during recovery) only occurred in 9 KA group patients. In spite of adverse effect, all patients recovered, were discharged and there were no reported delayed events.

• Journal of Veterinary Clinics
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• v.29 no.3
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• pp.220-225
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• 2012

This study examined the anesthetic and cardiopulmonary effects of xylazine or medetomidine in combination with ketamine-butorphanol in dogs. Five dogs were used in both the medetomidine-ketamine-butorphanol (MKB) group and the xylazine-ketamine-butorphanol (XKB) group. The procedures for the two groups were performed 4 weeks apart. MKB group showed a shorter duration for anesthesia than XKB group. Other factors were not statistically significant between the two groups. The MKB group showed signs of bradycardia, therefore cautious patient monitoring is necesessary. The XKB showed a longer anesthetic time and less adverse effects, however the MKB combination was more expensive and had less advantages. In conclusion, the results suggested the recommended use of both MKB and XKB in procedures that need approximately 50 minutes. If patients have a risk of bradycardia, one should be cautious of using a medetomidine-xylazine-butorphanol combination. Both MKB and XKB did not have much adverse effects; however MKB did not have advantages when compared to XKB. Therefore, XKB may be more effective when compared to MKB.

• Journal of Veterinary Clinics
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• v.29 no.1
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• pp.12-17
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• 2012

Many drugs are administered intramuscularly to immobilize and anesthetize dogs. There are many established intramuscular (IM) anesthetic combinations for dogs; however, little information is available on the effects of a xylazinediazepam-ketamine (XDK) combination. The purpose of this study was to investigate the anesthetic effects of the XDK combination in dogs. Twelve adult mixed bred dogs were used. All dogs were anesthetized with an IM injection of diazepam (0.5 mg/kg) and xylazine (1.1 mg/kg) with low-dose ketamine (5 mg/kg; group 1) or high-dose ketamine (10 mg/kg; group 2) in one syringe. After administration of the test dose, the animals were positioned in a right lateral recumbency, and analgesia and cardiopulmonary data were collected and recorded. The duration of anesthesia in group 2 was significantly longer than that of group 1 (mean [sd] 68.0 [7.6] v 51.3 [2.7] minutes). Blood pressure increased significantly after XDK administration in both groups, and $S_aO_2$ levels decreased significantly from baseline at 10, 20, and 30 minutes in both groups. XDK administration produced satisfactory sedation and analgesia in all dogs. In conclusion, intramuscular administration of xylazine-diazepam-ketamine combination at a doses of 1.1 mg/kg xylazine, 0.5 mg/kg diazepam, and 5 or 10 mg/kg ketamine appeared to be effective short duration anesthetic protocols in dogs.

• Korean Journal of Biological Psychiatry
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• v.20 no.2
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• pp.29-30
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• 2013

First-line therapy of depression is a pharmacological treatment. Many prescribed antidepressants modulate monoamine neurotransmitters including serotonin, norepinephrine and dopamine. Recently, Ketamine, an N-methyl-D-aspartate receptor antagonist, has received attention and has been investigated for clinical trials and neurobiological studies. Here, I introduce ketamine as a rapid-acting antidepressant.

• Journal of Veterinary Clinics
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• v.23 no.4
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• pp.393-399
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• 2006

Ketamine, one of general anesthetics for human and veterinary use, is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist which interferes with the action of excitatory amino acids. It has been reported to impair various leukocyte functions. In this study, the effect of ketamine on the oxidative burst activity (OBA) of canine peripheral blood leukocytes was examined. The OBA of canine peripheral blood phagocytes was analyzed by flow cytometry system. Ketamine at higher concentration such as $1,000{\mu}M$ exhibited a low viability of leukocytes. Thus, ketamine was used at concentration of 10 to $500{\mu}M$ showing no cytotoxic effect and high cell viability. The OBA of leukocytes in the presence or absence of latex beads was analyzed by addition of dihydrorhodamine 123. The direct treatment of ketamine revealed the inhibitory effect on the OBA of peripheral blood polymorphonuclear cells (PMN) and monocyte-rich cells but not peripheral blood mononuclear cells (PBMC) in the presence of latex beads. However, when latex beads were not added to PMN, its OBA was not inhibited by ketamine. The OBA of PMN and monocyte-rich cells but not PBMC in the presence of latex beads was also inhibited by culture supernatant from ketamine-treated- PBMC but not -PMN. But the OBA of PMN in the absence of latex beads was not inhibited by culture supernatant from PBMC treated with ketamine. Therefore, these results suggested that ketamine has the inhibitory effect on the OBA of canine peripheral blood phagocytes such as neutrophils and monocytes during phagocytic response.

• Journal of Korean Academy of Nursing
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• v.36 no.1
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• pp.114-126
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• 2006

Purpose: This study was performed to evaluate the pre-emptive analgesic effects of a small dose of intravenous ketamine on postoperative pain in patients undergoing a hysterectomy. Method: Sixty patients undergoing a hystrectomy under general anesthesia were randomly allocated to 2 groups. The experimental group(30 patients) received 0.3mg/kg of ketamine after induction of anesthesia, approximately 5 min prior to surgery, but the control group(30 patients)did not receive ketamine. Data was collected in a double-blind manner from April 1st, to October 30th, 2004. Postoperatively, the patients used a patient-controlled analgesia(PCA) pump. Blood pressure, pulse rate, pain, anxiety, count of times pressing the PCA button, administeration of additional analgesics and side effects of ketamine were measured at 1 hour, 3 hours, 6 hours and 24 hours after the operation. Result: There were no statistical differences in blood pressure, pulse rate, pain and anxiety between the experimental and control groups. There were statistical differences in blood pressure, pulse rate, pain and anxiety during the 24 hours postoperatively. In the experimental group, the number of times pressing the PCA button and administering additional analgesic drugs were significantly lower than those of the control group. Conclusion: A 0.3 mg/kg dose of ketamine given at approximately 5 min before surgery resulted in decreasing the number of times pressing the PCA and the administration of additional analgesics.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.87-90
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• 2006

Background: There are many ways to provide superior analgesia for postoperative pain after abdominal surgery of which epidural analgesics with opioids and local analgesics are the most useful. In an effort to maximize the level of analgesia and to minimize the side effects, ketamine, midazolam, clonidine, and adrenalin can be co-administrated as an adjuvant. This study examined the analgesic effect and side effects of midazolam compared with those given an epidural injection of bupivacaine, fentanyl and ketamine. Methods: In a double blind randomized controlled trial, 50 patients received either fentanyl $0.3{\mu}g/kg/h$ and ketamine 0.1 mg/kg/h (Group FK) or fentanyl $0.3{\mu}g/kg/h$, ketamine 0.1 mg/kg/h and midazolam 0.4 mg/h (Group FKM), added to 0.125% of bupivacaine at a rate of as much as 2 ml/h, for patient controlled epidural analgesia (PCEA) after low abdominal surgery. Ten minutes before surgery, the patients received either 10 ml of 0.125% bupivacaine with 0.5 mg/kg of ketamine or 10 ml of 0.125% bupivacaine with the same amount of normal saline, added to fentanyl $50{\mu}g$. The pain score and the side effects were recorded at 1, 3, 6, and 24 hours after surgery. Results: There was no difference in the pain score except for the VAS on coughing 1 hour after surgery. FKM group had fewer side effects. Conclusions: There was a better analgesic effect and fewer side effects with the addition of epidural midazolam to bupivacaine and fentanyl with ketamine formula. However, more study on the dose and route of administration will be needed.

• The Korean Journal of Pain
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• v.26 no.3
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• pp.270-276
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• 2013

Background: Ketamine, an N-methyl-D-aspartate receptor antagonist, might play a role in postoperative analgesia, but its effect on postoperative pain after caesarean section varies with study design. We investigated whether the preemptive administration of low-dose intravenous ketamine decreases postoperative opioid requirement and postoperative pain in parturients receiving intravenous fentanyl with patient-controlled analgesia (PCA) following caesarean section. Methods: Spinal anesthesia was performed in 40 parturients scheduled for elective caesarean section. Patients in the ketamine group received a 0.5 mg/kg ketamine bolus intravenously followed by 0.25 mg/kg/h continuous infusion during the operation. The control group received the same volume of normal saline. Immediately after surgery, the patients were connected to a PCA device set to deliver 25-${\mu}g$ fentanyl as an intravenous bolus with a 15-min lockout interval and no continuous dose. Postoperative pain was assessed using the cumulative dose of fentanyl and visual analog scale (VAS) scores at 2, 6, 24, and 48 h postoperatively. Results: Significantly less fentanyl was used in the ketamine group 2 h after surgery (P = 0.033), but the difference was not significant at 6, 12, and 24 h postoperatively. No significant differences were observed between the VAS scores of the two groups at 2, 6, 12, and 24 h postoperatively. Conclusions: Intraoperative low-dose ketamine did not have a preemptive analgesic effect and was not effective as an adjuvant to decrease opioid requirement or postoperative pain score in parturients receiving intravenous PCA with fentanyl after caesarean section.

• Advances in pediatric surgery
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• v.19 no.2
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• pp.73-80
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• 2013

Ketamine is a safe and effective drug for pediatric anesthesia, sedation and analgesia. We hoped to identify that surgeons could operate a pediatric hernia with the ketamine anesthesia without general anesthesia. The study was a consecutive case series of 2230 inguinal hernia patients aged 1 months to 17 years in a Joo's day-surgical clinic during 11-year period. The patients had pediatric inguinal hernia surgery without general anesthesia under the day-surgery system. We retrospectively analyzed the medical record of patients who were registered with the Diagnosis Related Group (DRG) system. All patients received ketamine (5mg/kg) and atropine (0.01mg/kg) intramuscularly before surgery. After anesthesia, we injected 1~2% lidocaine (Less than 5ml) subcutaneously at the site of incision and started operation. The surgical method was the high ligation method of the hernia sac.) In total 2230 patients, male were 1756 and female were 474. 2076 patients were a unilateral inguinal hernia at the time of surgery and 154 were bilateral hernia patients. Less than three months, depending on the age of the patients was 391, and less than 12 months the patient was 592 people (26.5%). After surgery, there were no accidents or long term complications associated with ketamine anesthesia. We think the surgeon can safely do the pediatric inguinal hernia surgery using ketamine and lidocaine without anesthesiologist through 11 years of our surgical experiences.

• Journal of Veterinary Clinics
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• v.25 no.2
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• pp.73-78
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• 2008

Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist and a short-acting general anaesthetic agent for human and veterinary use. We previously reported that treatment with ketamine impairs oxidative burst activity of canine peripheral blood leukocytes. In this study, the effect of ketamine on phagocytic capacity of canine peripheral blood leukocytes was examined in vitro. Phagocytic capacity was analyzed by using a flow cytometry. Ketamine directly decreased the phagocytic capacity of peripheral blood polymorphonuclear cells (PMN) and monocytes but not total peripheral blood mononuclear cells (PBMC). In addition, the phagocytic capacity of PMN and monocytes was inhibited by the ketamine-treated PBMC but not PMN culture supernatant. These results suggest that ketamine has a direct inhibitory effect on the phagocytic capacity of canine peripheral blood phagocytes and involves the production of soluble factor(s) from canine PBMC, which may suppress the phagocytic capacity.