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Ian M Anderson, Andrew Blamire, Tim Branton, Ross Clark, Darragh Downey, Graham Dunn, Andrew Easton, Rebecca Elliott, Clare Elwell, Katherine Hayden, Fiona Holland, Salman Karim, Colleen Loo, Jo Lowe, Rajesh Nair, Timothy Oakley, Antony Prakash, Parveen K Sharma, Stephen R Williams, R Hamish McAllister-Williams
BACKGROUND: The use of electroconvulsive therapy (ECT) is limited by concerns about its cognitive adverse effects. Preliminary evidence suggests that administering the glutamate antagonist ketamine with ECT might alleviate cognitive adverse effects and accelerate symptomatic improvement; we tested this in a randomised trial of low-dose ketamine. METHODS: In this multicentre, randomised, parallel-group study in 11 ECT suites serving inpatient and outpatient care settings in seven National Health Service trusts in the North of England, we recruited severely depressed patients, who were diagnosed as having unipolar or bipolar depressive episodes defined as moderate or severe by DSM-IV criteria, aged at least 18 years, and were able and willing to provide written consent to participate in the study...
May 2017: Lancet Psychiatry
Steven M Green, Mark G Roback, Baruch Krauss, Lance Brown, Ray G McGlone, Dewesh Agrawal, Michele McKee, Markus Weiss, Raymond D Pitetti, Mark A Hostetler, Joe E Wathen, Greg Treston, Barbara M Garcia Pena, Andreas C Gerber, Joseph D Losek
STUDY OBJECTIVE: Although ketamine is one of the most commonly used sedatives to facilitate painful procedures for children in the emergency department (ED), existing studies have not been large enough to identify clinical factors that are predictive of uncommon airway and respiratory adverse events. METHODS: We pooled individual-patient data from 32 ED studies and performed multiple logistic regressions to determine which clinical variables would predict airway and respiratory adverse events...
August 2009: Annals of Emergency Medicine
E Stein Bronsky, Catherine Koola, Alessandro Orlando, Diane Redmond, Cecile D'Huyvetter, Heather Sieracki, Allen Tanner, Ray Fowler, Charles Mains, David Bar-Or
OBJECTIVE: A few studies report comparable analgesic efficacy between low-dose ketamine and opioids such as morphine or fentanyl; however, limited research has explored the safety and effectiveness of intravenous low-dose ketamine as a primary analgesic in a civilian prehospital setting. The objective of this study is to compare pain control between low-dose ketamine and fentanyl when administered intravenously (IV) for the indication of severe pain. METHODS: This was a retrospective, observational review of prehospital adult patients (≥18 years) who presented with severe pain (numeric rating scale, 7-10) and were treated solely with either low-dose ketamine IV or fentanyl IV between January 1, 2014 and December 31, 2016...
May 18, 2018: Prehospital Emergency Care
Sergey Motov, Stefan Mann, Jefferson Drapkin, Mahlaqa Butt, Antonios Likourezos, Elizabeth Yetter, Jason Brady, Nechama Rothberger, Ankit Gohel, Peter Flom, Mo Mai, Christian Fromm, John Marshall
STUDY OBJECTIVE: We compare the analgesic efficacy and safety of subdissociative intravenous-dose ketamine (SDK) versus morphine in geriatric Emergency Department (ED) patients. METHODS: This was a prospective, randomized, double-blind trial evaluating ED patients aged 65 and older experiencing moderate to severe acute abdominal, flank, musculoskeletal, or malignant pain. Patients were randomized to receive SDK at 0.3 mg/kg or morphine at 0.1 mg/kg by short intravenous infusion over 15 min...
February 2019: American Journal of Emergency Medicine
Nicholas Karlow, Charles H Schlaepfer, Carolyn R T Stoll, Michelle Doering, Christopher R Carpenter, Graham A Colditz, Sergey Motov, Joshua Miller, Evan S Schwarz
BACKGROUND: Opioids are commonly prescribed in the emergency department (ED) for the treatment of acute pain. Analgesic alternatives are being explored in response to an epidemic of opioid misuse. Low-dose ketamine (LDK) is one opioid alternative for the treatment of acute pain in the ED. OBJECTIVES: This systematic review and meta-analysis sought to quantify whether LDK is an effective and safe opioid alternative for acute pain reduction in adults in the ED setting...
July 17, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Sergey Motov, Jefferson Drapkin, Antonios Likourezos, Tyler Beals, Ralph Monfort, Christian Fromm, John Marshall
Introduction: Our objective was to describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). Methods: We conducted a retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over six years (2010-2016)...
May 2018: Western Journal of Emergency Medicine
Seyed Mohammad Hosseininejad, Fatemeh Jahanian, Salman Erfanian Irankar, Mahmood Moosazadeh, Seyed Adel Hosseini, Niloufar Shahbakhti, Farzad Bozorgi
OBJECTIVES: Renal colic (RC) is a common cause for emergency department visits. This study was conducted to compare the analgesic efficacy of morphine plus ketamine (MK) versus morphine plus placebo (MP) in patients with acute renal colic. METHOD: Using a single center, double-blind, two-arm, parallel-group, randomized controlled trial, 200 patients were equally and randomly divided to receive 0.1 mg/kg morphine plus normal saline and 0.1 mg/kg morphine plus 0...
September 3, 2018: American Journal of Emergency Medicine
Sergey Motov, Bradley Rockoff, Victor Cohen, Illya Pushkar, Antonios Likourezos, Courtney McKay, Emil Soleyman-Zomalan, Peter Homel, Victoria Terentiev, Christian Fromm
STUDY OBJECTIVE: We assess and compare the analgesic efficacy and safety of subdissociative intravenous-dose ketamine with morphine in emergency department (ED) patients. METHODS: This was a prospective, randomized, double-blind trial evaluating ED patients aged 18 to 55 years and experiencing moderate to severe acute abdominal, flank, or musculoskeletal pain, defined as a numeric rating scale score greater than or equal to 5. Patients were randomized to receive ketamine at 0...
September 2015: Annals of Emergency Medicine
Alice Gallo de Moraes, Carlos J Racedo Africano, Sumedh S Hoskote, Dereddi Raja S Reddy, Rudy Tedja, Lokendra Thakur, Jasleen K Pannu, Elizabeth C Hassebroek, Nathan J Smischney
BACKGROUND: Endotracheal intubation is a common procedure performed for critically ill patients that can have immediate life-threatening complications. Induction medications are routinely given to facilitate the procedure, but most of these medications are associated with hypotension. While etomidate is known for its neutral hemodynamic profile, it has been linked with increased mortality in septic patients and increased morbidity in trauma patients. Ketamine and propofol are effective anesthetics with counteracting cardiovascular profiles...
February 13, 2015: American Journal of Case Reports
Ellen E Lee, Megan P Della Selva, Anson Liu, Seth Himelhoch
OBJECTIVE: Given the significant disability, morbidity and mortality associated with depression, the promising recent trials of ketamine highlight a novel intervention. A meta-analysis was conducted to assess the efficacy of ketamine in comparison with placebo for the reduction of depressive symptoms in patients who meet criteria for a major depressive episode. METHOD: Two electronic databases were searched in September 2013 for English-language studies that were randomized placebo-controlled trials of ketamine treatment for patients with major depressive disorder or bipolar depression and utilized a standardized rating scale...
March 2015: General Hospital Psychiatry
Paul A Jennings, Peter Cameron, Stephen Bernard, Tony Walker, Damien Jolley, Mark Fitzgerald, Kevin Masci
STUDY OBJECTIVE: We assess the efficacy of intravenous ketamine compared with intravenous morphine in reducing pain in adults with significant out-of-hospital traumatic pain. METHODS: This study was an out-of-hospital, prospective, randomized, controlled, open-label study. Patients with trauma and a verbal pain score of greater than 5 after 5 mg intravenous morphine were eligible for enrollment. Patients allocated to the ketamine group received a bolus of 10 or 20 mg, followed by 10 mg every 3 minutes thereafter...
June 2012: Annals of Emergency Medicine
Francesca L Beaudoin, Charlie Lin, Wentao Guan, Roland C Merchant
OBJECTIVES: Low-dose ketamine has been used perioperatively for pain control and may be a useful adjunct to intravenous (IV) opioids in the control of acute pain in the emergency department (ED). The aim of this study was to determine the effectiveness of low-dose ketamine as an adjunct to morphine versus standard care with morphine alone for the treatment of acute moderate to severe pain among ED patients. METHODS: A double-blind, randomized, placebo-controlled trial with three study groups was conducted at a large, urban academic ED over a 10-month period...
November 2014: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Shernaz Wadia, Rahul Bhola, Douglas Lorenz, Pradeep Padmanabhan, Joshua Gross, Michelle Stevenson
STUDY OBJECTIVE: We determine the increase in intraocular pressure during pediatric procedural sedation with ketamine, and the proportion of children whose increase might be clinically important (at least 5 mm Hg). METHODS: We prospectively enrolled children aged 8 to 18 years, chosen to receive ketamine sedation in a pediatric emergency department. We measured intraocular pressure before sedation, immediately after ketamine administration, 2 minutes post-drug administration, and every 5 minutes thereafter until recovery or 30 minutes after the final dose...
October 2014: Annals of Emergency Medicine
Anita Slomski
No abstract text is available yet for this article.
July 23, 2014: JAMA: the Journal of the American Medical Association
Tarek Shams, Ragaa El-Masry
BACKGROUND AND AIMS: The choice of anaesthetic agent for electroconvulsive therapy (ECT) depends on seizure duration, haemodynamic, and recovery parameters. The aim of the study was to assess the effects of ketamine-propofol induction with dexmedetomidine preadministration (ketofol-dex group) and without its preadministration (ketofol group) on haemodynamics, depression, seizure duration, recovery characteristics, and agitation following ECT in patients with depression. METHODS: 40 patients aged 18-60 years were scheduled for ECT for treatment of depression...
May 2014: Indian Journal of Anaesthesia
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