• Journal of Veterinary Clinics
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• v.10 no.2
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• pp.237-242
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• 1993

Combined intramuscular administration of ketamine 8mg/kg. xylazine 2mg/kg were done to evaluate effect of anesthesia in Siberian tiger White tiger and Bengal tiger. Mean induction time(MIT), mean arousal time-(MAT). mean walking time(MWT) and clinical sign were evaluated. The results were as follows. MIT were taken 16.1$\pm$3.5 minutes for Siberian tiger. 15.5$\pm$2.4 minutes for White tiger and 12.3$\pm$2.5 minutes for Bengal tiger. MAT were taken 44.2$\pm$9.5 minutes for Siberian tiger, 48.3$\pm$8.6 minutes for White tiger and 58.7$\pm$5.8 minutes for Bengal tiger. MWT were taken 110.6$\pm$11.6 minutes for Siberian tiger, 106.7$\pm$13.1 minutes for White tiger and 99.6$\pm$10.2 minutes for Bengal tiger. Nausea. vomiting. salivation. severe convulsion. sudden decreased respiration and dyspnea were observed in Siberian tiger during sedation and anesthesia. Also, nausea, vomiting, salivation and convulsion were observed in White tiger and Bengal tiger but the clinical signs were more mild than Siberian tiger. The Bengal tiger which used combined ketamine 5mg/kg , xylazine 1mg/kg were shown reduced induction time compare with combined administration ketamine 8mg/kg, xylazine 2mg/kg in Bengal tiger as 10.8$\pm$32 minutes for MIT. 32.3$\pm$4.3 minutes for MAT and 78.5$\pm$7.3 minutes for MWT Vomiting and convulsion were observed during induction time but there were no nausea and salivation. The present results suggested that preventive methods against severe convulsion and dyspnea should be required in Siberian tiger when combined anesthesia of ketamine 8mg/kg, xylazine 2mg/kg used. Combined anesthesia of ketamine 5mg/kg, xylazine 1mg/kg in Bengal tiger might be very effective for simple surgical procedure and diagnosis.

• The Korean Journal of Pain
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• v.24 no.3
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• pp.137-140
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• 2011

Background: Although early reviews of clinical findings were mostly negative, there is still a widespread belief for the efficacy of preemptive analgesia among clinicians. In this study, we evaluated whether the preemptive use of ketamine decreases post operative pain in patients undergoing appendectomy. Methods: In double-blind, randomized clinical trials, 80 adult male patients undergoing an operation for acute appendicitis were studied. Patients were randomly assigned to two groups. In the operating room, patients in the ketamine group received 0.5 mg/kg of ketamine IV 10 minutes before the surgical incision. In the control group, 0.5 mg/kg of normal saline was injected. The pain intensity was assessed at time 0 (immediately after arousal) and 4, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). Results: Eighty patients (40 for both groups) were enrolled in this study. For all of the evaluated times, the VAS score was significantly lower in the ketamine group compared to the control. The interval time for the first analgesic request was $23.1{\pm}6.7$ minutes for the case group and $18.1{\pm}7.3$ minutes for the control (P = 0.02). The total number of pethidine injections in the first 24 hours postoperatively was $0.6{\pm}0.6$ for the case group and $2.0{\pm}0.8$ for the controls (P = 0.032). There were no drug side effects for the case group. Conclusions: A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after appendectomy.

• The Korean Journal of Pain
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• v.22 no.1
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• pp.39-46
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• 2009

Background: Ketamine has an indirect sympathetic stimulation effect. We investigated heart rate variability (HRV) as a marker of cardiac autonomic function after a target controlled infusion (TCI) of ketamine with a plasma concentration of 30 or 60 ng/ml. Methods: In 20 adult volunteers, the mean of the R wave to the adjacent R wave interval (RRI), the range of RRI, the root mean square successive difference of intervals (RMSSD), the total power, the low frequency (LF, 0.04-0.15 Hz) power, the high frequency (HF, 0.15-0.4 Hz) power, the normal unit HF (nuHF), the normal unit LF (nuLF), the LF/HF ratio and the SD1 and the SD2 in the Poincare plot were measured before and after a TCI of ketamine. We observed for any psychedelic symptoms or sedation. Results: There were no differences in the mean and range of the RRI, RMSSD, total power, LF power, HF power, nuHF, nuLF, LF/HF ratio, SD1 and SD2 between before and after ketamine administration. The OAA/S score was higher and there were more psychedelic symptoms with a 60 ng/ml plasma concentration than with a 30 ng/ml plasma concentration. Conclusions: This study did not show any effect of a low plasma concentration of ketamine on the autonomic nervous system.

• Journal of Hospice and Palliative Care
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• v.19 no.3
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• pp.249-255
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• 2016

Purpose: Up to 90% of pancreatic cancer patients suffer from neuropathic pain. In a palliative care setting, pain control in pancreatic cancer patient is one of the major goals. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, effective in neuropathic pain. Additionally, there have been studies about the opioid sparing effect of ketamine. This study was held in the palliative care unit among pancreatic cancer patients to determine the factors related to ketamine use and the opioid sparing effect. Methods: The medical records of pancreatic cancer patients admitted to St. Mary's hospital palliative care unit between January, 2013 and December, 2014 were reviewed. Patients were divided into 2 categories according to ketamine use. Also, opioid use before and after ketamine use was compared in the ketamine group. Results: Compared to the non-ketamine use group, patients in the ketamine group required a higher dose of opioid. The total opioid dose, daily opioid dose, number of daily rescue medications, and daily average rescue dose were statistically significantly higher in the ketamine group. The opioid requirement was increased after ketamine administration. Conclusion: In this retrospective study, ketamine was frequently considered in patients with severe pain, requiring higher amount of opioid. Studies about palliative use of ketamine in a larger number of patients with diverse types of cancer pain are required in the future.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.1
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• pp.38-44
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• 2015

Children commonly experience orofacial injuries and often need emergency treatment. Due to fear and anxiety, children tend to be uncooperative in emergency rooms. Ketamine hydrochloride is a well-known sedative agent at medical-based emergency rooms which has been used for procedural sedation. In this paper, we will discuss the sedation of uncooperative young patients, who needed dental treatments in the emergency room at Wonju Severance Christian Hospital, using ketamine. We collected the records of patients under 18-years-old who visited the emergency room for dental treatment from January 2010 to May 2014. The data was categorized by age, sex, required dental treatments and application of ketamine sedation. Among 659 pediatric patients who visited for emergency dental treatments, 118 patients were treated under sedation using ketamine. Majority of patients were under the age of 6 (110 patients), and the most frequent cause of sedation was suture of oral laceration (105 patients). Though ketamine should not be used by dentists alone, dentists in emergency rooms can easily meet the patients under deep sedation using ketamine. Hence, dentists in emergency rooms need to be aware of the clinical effects, considerations, and potential adverse effects of ketamine.

• Korean Journal of Biological Psychiatry
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• v.5 no.1
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• pp.83-94
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• 1998

Objectives : Phencyclidine(PCP) or PCP-like substances such as ketamine have been known to rekindle the cognitive dysfunction in schizophrenia. The aims of this study were to identify whether PCP-like substances can produce cognitive deficit in schizophrenia, to discuss relation with aging process, and finally to speculate underlying neurochemical mecha-nisms by various drug responses. Methods : In experiment I, radial maze tests were done in 24 Sprague-Dawley rats for 3 days to get baseline data. Being divided into 4 groups(6 rats respectively) of normal aged, normal adult controls, atropine-treated and ketamine-treated, the radial maze tests were repeated on every week for 6 weeks, and then the rats were sacrificed by intracardiac perfusion with phosphate-buffered 10% formaldehyde solution for histology. The brain specimen was stained with hematoxylin-eosin to count cells in the prefrontal cortex and hippocampus. In experiment II, radial maze tests were done for 48 rats before any drug treatment and only after ketamine administration. Thereafter, haloperidol, bromocriptine, clonidine, nimodipine, tacrine, valproic acid, naloxone and fluoxetine were intramuscularly injected on every other day in addition to ketamine. Radial maze tests were repeated on every week for 6 weeks, and then rats were prepared by the same procedure for histology. Results : 1) Reaction times of radial maze tests of atropine-treated rats were significantly prolonged than those of normal aged(p<0.05) or normal adult controls(p<0.05). Cell numbers of prefrontal cortex & hippocampus in ketamine-treated rats were significantly reduced than those in normal aged (p<0.05) or normal adult controls(p<0.005). 2) Reduced cell numbers by ketamine became significantly raised by tacrine administration in prefrontal cortex & hippocampus(p<0.05), while there were no significant changes on radial maze tests. Cell numbers also tended to be raised by nimodipine, fluoxetine and haloperidol administration. Conclusions : In conclusion, the visuospatial memory disorders in ketamine-induced psychotic rats might be partly asso-ciated with aging process. Furthermore, the responses to the various drugs suggested cholinergic system might have an important role in the neurochemical mechanism of the cognitive dysfunction in ketamine-induced psychosis. Otherwise, calcium metabolism as well as serotonergic and dopaminergic systems seemed to be possibly related.

• The Korean Journal of Physiology and Pharmacology
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• v.12 no.3
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• pp.101-109
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• 2008

The aim of the present study was to examine the effects of ketamine, a dissociative anesthetics, on secretion of catecholamines (CA) secretion evoked by cholinergic stimulation from the perfused model of the isolated rat adrenal gland, and to establish its mechanism of action, and to compare ketamine effect with that of thiopental sodium, which is one of intravenous barbiturate anesthetics. Ketamine ($30{\sim}300{\mu}M$), perfused into an adrenal vein for 60 min, dose- and time-dependently inhibited the CA secretory responses evoked by ACh (5.32 mM), high $K^+$ (a direct membrane-depolarizer, 56 mM), DMPP (a selective neuronal nicotinic NN receptor agonist, $100{\mu}M$) and McN-A-343 (a selective muscarinic M1 receptor agonist, $100{\mu}M$). Also, in the presence of ketamine ($100{\mu}M$), the CA secretory responses evoked by veratridine (a voltage-dependent $Na^+$ channel activator, $100{\mu}M$), Bay-K-8644 (an L-type dihydropyridine $Ca^{2+}$ channel activator, $10{\mu}M$), and cyclopiazonic acid (a cytoplasmic $Ca^{2+}$-ATPase inhibitor, $10{\mu}M$) were significantly reduced, respectively. Interestingly, thiopental sodium ($100{\mu}M$) also caused the inhibitory effects on the CA secretory responses evoked by ACh, high $K^+$, DMPP, McN-A-343, veratridine, Bay-K-8644, and cyclopiazonic acid. Collectively, these experimental results demonstrate that ketamine inhibits the CA secretion evoked by stimulation of cholinergic (both nicotinic and muscarinic) receptors and the membrane depolarization from the isolated perfused rat adrenal gland. It seems likely that the inhibitory effect of ketamine is mediated by blocking the influx of both $Ca^{2+}$ and $Na^+$ through voltage-dependent $Ca^{2+}$ and $Na^+$ channels into the rat adrenal medullary chromaffin cells as well as by inhibiting $Ca^{2+}$ release from the cytoplasmic calcium store, which are relevant to the blockade of cholinergic receptors. It is also thought that, on the basis of concentrations, ketamine causes similar inhibitory effect with thiopental in the CA secretion from the perfused rat adrenal medulla.

• The Korean Journal of Pain
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• v.18 no.1
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• pp.39-42
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• 2005

Background: Besides its general anesthetic effect, ketamine interacts with sodium channels in a local anesthetic-like fashion, including the sharing of binding sites with those commonly used by clinical local anesthetics. This study evaluated the dose related effects of ketamine during epidural anesthesia with 0.5% ropivacaine. Methods: Sixty ASA physical status I II patients, scheduled for minor elective surgery under epidural anesthesia using 0.5% ropivacaine, were randomly divided into three groups (n = 20 each). The patients initially received either 0.5% ropivacaine (group 1), ketamine (0.1 mg/kg) in addition to the epidural 0.5% ropivacaine (group 2) or ketamine (0.2 mg/kg) in addition to the epidural 0.5% ropivacaine (group 3). The regression of sensory block was assessed by transcutaneous electric stimulation (TES), equivalent to a surgical incision. Motor block was assessed using the Modified Bromage's scale. Episodes of bradycardia, hypotension and sedation were also recorded. Results: There were no significant differences among the three groups in the maximal levels of sensory block or the times taken for these levels to be reached. The mean times for the block to regress to two and four segments below the maximal level were significantly prolonged by epidural ketamine. Conclusions: Epidural ketamine prolongs the duration of ropivacaine epidural anesthesia. These results suggest that ketamine has local anesthetic-like actions.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.87-90
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• 1988

In recent years the use of epidural opiates has increased and although this method of pain relief has shown good results in clinical practice It is still subject to certain drawbacks, the most serious of which appears to be delayed respiratory depression. Since ketamine administered systemically is unlikely to produce respiratory depression it seemed worthwhile to investigate the possibility of exploiting the potent analgesic property to ketamine by its epidural administration. The analgesic effect of ketamine 4 mg, administered epidural space, was evaluated. The duration of pain relief varied from less than 3 hours in 20% to over 24 hours in 30% of the cases. In 62.5% of the cases pain relief exceeded 6 hours. There was no evidence of respiratory depression, and there no postoperative neurologic sequelae. The present results indicated the need for further studies to compare the efficacy and safety of epidural ketamine with the response to epidural opioids for the relief of postoperative pain.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.3
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• pp.151-158
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• 2019

Background: This study aimed to examine whether the combination of low-dose ketamine and propofol in deep sedation is clinically useful in controlling the behavior in intellectually disabled patients who are typically extremely noncooperative during dental procedures. Methods: A total of 107 extremely noncooperative intellectually disabled adult patients were analyzed. In all patients, deep sedation was performed using either propofol alone (group P) or using a combination of propofol and 0.2 mg/kg or 0.4 mg/kg ketamine (groups PK0.2 and PK0.4, respectively). The procedures were performed in the order of insertion of nasal cannula into the nostril, attachment of mouth gag, and mouth cleaning and scaling. The frequency of patient movement during the procedures, mean arterial pressure, heart rate, peripheral oxygen saturation, recovery time, discharge time, and postoperative nausea and vomiting were examined. Results: The three groups were significantly different only in the frequency of patient movement upon stimulation during single intravenous injection of propofol and scaling. Conclusion: For propofol deep sedation, in contrast to intravenous injection of propofol alone, prior intravenous injection of low-dose ketamine (0.4 mg/kg) is clinically useful because it neither affects recovery, nor causes side effects and can suppress patient movement and vascular pain during procedures.