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ketamine epidural

Gloria S Cheng, Brian M Ilfeld
OBJECTIVE: To review the published evidence regarding perioperative analgesic techniques for breast cancer-related surgery. DESIGN: Topical review. METHODS: Randomized, controlled trials (RCTs) were selected for inclusion in the review. Also included were large prospective series providing estimates of potential risks and technical reports and small case series demonstrating a new technique or approaches of interest to clinicians. RESULTS: A total of 514 abstracts were reviewed, with 284 studies meeting criteria for full review...
August 22, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Vigya Goyal, Jyotsna Kubre, Krishnaprabha Radhakrishnan
CONTEXT: Postoperative pain management is becoming an integral part of anesthesia care. Various techniques of pediatric pain relief have been designed among which the most commonly practiced is caudal epidural block. Several adjuvants have been used to prolong the duration of caudal analgesia such as clonidine, neostigmine, ketamine, opioids, and ephedrine. We have designed the study using dexmedetomidine as an adjuvant to assess analgesic efficacy, duration of postoperative analgesia, hemodynamic stability, postoperative sedation, and any adverse effects in children...
May 2016: Anesthesia, Essays and Researches
Alejandra G Mora, Victoria J Ganem, Alicia T Ervin, Joseph K Maddry, Vikhyat S Bebarta
INTRODUCTION: U.S. Critical Care Air Transport Teams (CCATTs) evacuate critically ill patients with acute pain in the combat setting. Limited data have been reported on analgesic administration en route, and no study has reported analgesic use by CCATTs. Our objective was to describe analgesics used by CCATTs for nonintubated, critically ill patients during evacuation from a combat setting. METHODS: We conducted an institutional review board-approved, retrospective review of CCATT records...
May 2016: Military Medicine
Scott T Benken, Alexandra Goncharenko
This report describes a patient case utilizing a nontraditional sedative, continuous infusion ketamine, as an alternative agent for intensive care unit (ICU) sedation. A 27-year-old female presented for neurosurgical management of a coup contrecoup injury, left temporal fracture, epidural hemorrhage (EDH), and temporal contusion leading to sustained mechanical ventilation. The patient experienced profound agitation during mechanical ventilation and developed adverse effects with all traditional sedatives: benzodiazepines, dexmedetomidine, opioids, and propofol...
May 2, 2016: Journal of Pharmacy Practice
A Schulze, C Tran, V Levandovskiy, V Patel, M A Cortez
Deficiency of guanidinoacetate methyltransferase (GAMT) causes creatine depletion and guanidinoacetate accumulation in brain with the latter deemed to be responsible for the severe seizure disorder seen in affected patients. We studied electrical brain activity and GABAA mediated mechanisms of B6J.Cg-Gamt(tm1Isb) mice. Electrocorticographic (ECoG) monitoring of pharmacological treatments with ornithine (5 % in drinking water for 5-18 days) and/or Picrotoxin (PTX) (a GABAA receptor antagonist) (1.5 mg/kg, I...
August 2016: Amino Acids
Hugh D de Pereira Cardoso, Natalie C Fim, Mariangela A Marques, Helio Mint, Vania M de Vasconcelos Machado, Daneshvari R Solanki, Rodrigo Moreira Lima, Ana L de Carvalho, Lais H Navarro, Eliana M Ganem
BACKGROUND: There is experimental evidence that dexmedetomidine has neuroprotective effects. So, it could be expected that its intrathecal or epidural administration presents no harm. However, whether dexmedetomidine is neurotoxic to the spinal cord remains to be fully elucidated. OBJECTIVE: To evaluate the effect of preservative-free dexmedetomidine administered as a subarachnoid single injection on the spinal cord and meninges of rabbits. STUDY DESIGN: Research article...
February 2016: Pain Physician
Pedro Boscan, Sara Wennogle
This is a retrospective study evaluating femoral-sciatic nerve blocks (FSBs), epidural analgesia, and non-regional analgesia (NRA) in dogs undergoing tibia-plateau-leveling-osteotomy surgery. Thirty-five records met the criteria for each of the FSB and epidural analgesia groups. Seventeen anesthesia records met the criteria for the NRA or control group. The parameters reported were: isoflurane vaporizer setting, rescue analgesia/anesthesia drugs received, heart rate, systolic blood pressure, and recovery quality (0-4, with 0 being poor and 4 being good)...
March 2016: Journal of the American Animal Hospital Association
Mahin Seyedhejazi, Majed Mashhoori, Rasoul Azarfarin, Daryoush Shekhzadeh, Nasrin Taghizadieh
BACKGROUND: The aim of the present study is to compare the success rate and complications of caudal epidural bupivacaine alone or in combination with intravenous (IV) midazolam and ketamine in awake infants undergoing lower abdominal surgery. MATERIALS AND METHODS: In this double-blind, clinical trial study, 90 infants (aged below 3 months and weight below 5 kg) with American Society of Anaesthesiologists I-II, were divided into three groups of each 30: Group 1 received bupivacaine 0...
October 2015: African Journal of Paediatric Surgery: AJPS
Brian M Radvansky, Khushbu Shah, Anant Parikh, Anthony N Sifonios, Vanny Le, Jean D Eloy
OBJECTIVES: The objective of this narrative review was to examine the usage of ketamine as a postoperative analgesic agent across a wide variety of surgeries. DESIGN: A literature search was performed using the phrases "ketamine" and "postoperative pain." The authors analyzed the studies that involved testing ketamine's effectiveness at controlling postoperative pain. Effectiveness was assessed through various outcomes such as the amount of opiate consumption, visual analog scale (VAS) pain scores, and persistent postoperative pain at long-term follow-up...
2015: BioMed Research International
Philippe Richebé, Marco Julien, Véronique Brulotte
PURPOSE: This manuscript proposes pharmacological strategies that might decrease persistent postsurgical pain (PPSP). These recommendations are based on a review of current publications available in the literature. PRINCIPAL FINDINGS: Persistent postsurgical pain has been defined by the International Association for the Study of Pain as clinical discomfort that lasts more than two months after surgery. Recent reviews reported that 10-50% of patients develop chronic pain after surgery, 2-10% with disabling chronic pain at six months...
December 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Waleed S H Farrag, Abdelrady S Ibrahim, Mostafa Galal Mostafa, Adel Kurkar, Ahmad A Elderwy
INTRODUCTION: Possible approaches for postoperative analgesia after pediatric inguinoscrotal surgery are caudal block by bupivacaine/ketamine (BK) and bupivacaine/magnesium sulfate (BM). AIM: The purpose of the following study is to compare the analgesic efficacy and safety of ketamine and magnesium sulfate in combination with bupivacaine for caudal blockade in pediatric patients after inguinoscrotal operations. MATERIALS AND METHODS: Patients randomly received one of the two solutions for caudal epidural injection after induction of general anesthesia...
July 2015: Urology Annals
Carl Ekstrand, Marie Sterning, Love Bohman, Anna Edner
BACKGROUND: In Sweden, scrotal or inguinal herniorrhaphy of livestock pigs in the field has traditionally been an important part of the surgical skills training of veterinary students. Few substances meet the legal requirements for field anaesthesia of production animals in the European Union but a protocol based on azaperone-detomidine-butorphanol-ketamine does. Unfortunately the anaesthesia is characterised by unpredictable duration and depth and of abrupt awakenings which is not acceptable from an animal welfare perspective and impedes surgical training...
2015: Acta Veterinaria Scandinavica
Alfonso Fiorelli, Antonio Mazzella, Beatrice Passavanti, Pasquale Sansone, Paolo Chiodini, Mario Iannotti, Caterina Aurilio, Mario Santini, Maria Caterina Pace
OBJECTIVES: To evaluate if the pre-emptive administration of ketamine would potentiate the effect of intravenous morphine analgesia in the management of post-thoracotomy pain. METHODS: This was a unicentre, double-blind, placebo-controlled, parallel-group, prospective study. Patients were randomly assigned to receive 1 mg/kg ketamine (ketamine group) or an equivalent dose of normal saline (placebo group) before thoracotomy in 1:1 ratio. All patients received postoperatively intravenous morphine administration as additional analgesic regimen...
September 2015: Interactive Cardiovascular and Thoracic Surgery
Erin Wendt-Hornickle, Lindsey B C Snyder
OBJECTIVE: To evaluate and compare the time to extubation in two commonly used methods of analgesia in dogs undergoing elective pelvic limb orthopedic procedures. STUDY DESIGN: Prospective, randomized, double-blinded clinical study. ANIMALS: Twenty-five adult, client-owned, healthy dogs aged 4.4 ± 1.6 years and weighing 38.5 ±3.5 kg. METHODS: All dogs were premedicated with dexmedetomidine (5-10 μg kg(-1)) intramuscularly (IM) and anesthesia was induced with propofol (2-6 mg kg(-1)) intravenously (IV)...
January 2016: Veterinary Anaesthesia and Analgesia
Steven B Porter, Robert L McClain, Bonnie L Howe, Albert E Ardon, Laura S Mazer, Brittany M Knestrick, Anna M Clendenen
Many common elective surgeries are associated with moderate-to-severe postoperative pain. These common surgeries include total knee and total hip arthroplasty, thoracotomy, and multilevel lumbar spine surgery. Unfortunately, many patients requiring these surgeries are already in moderate-to-severe pain, necessitating high doses of oral or transdermal opioids preoperatively. This is an established risk factor for difficult-to-control postoperative pain.(1,2) Opioid-sparing interventions are important elements in these patients to promote convalescence and reduce common opioid side effects such as constipation, confusion, pruritus, nausea, vomiting, and urinary retention...
June 2015: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
LinLi Luo, Juan Ni, Lan Wu, Dong Luo
Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1-L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg) for sedation and analgesia...
2015: Local and Regional Anesthesia
Jian-qing Chen, Zhen Wu, Lai-you Wen, Jian-zhong Miao, Yong-ming Hu, Ruiping Xue
BACKGROUND: Although pre-emptive analgesia is commonly used for the management of postoperative pain in developed countries, no defined protocol has been carried out and widely practiced, especially in transabdominal hysterectomy. Keeping this in mind the present study aimed to investigate the effects of multimodal pre-emptive analgesia on pain management, stress response and inflammatory factors of patients undergoing transabdominal hysterectomy to find an optimized way of pre-emptive analgesia...
2015: BMC Anesthesiology
Nagwa Ahmed Ebrahim Megahed, Mohamed Ellakany, Ahmed Mohammed Ibrahim Elatter, Mohamed Ahmed Ali Moustafa Teima
BACKGROUND: Neuraxial blocks result in sympathetic block, sensory analgesia and motor block. Continuous epidural anesthesia through a catheter offers several options for perioperative analgesia. Local anesthetic boluses or infusions can provide profound analgesia. Although the role of low-dose ketamine (<2 mg/kg intramuscular, <1 mg/kg intravenous [IV] or ≤ 20 μg/kg/min by IV infusion) in the treatment of post-operative pain is controversial, perioperative administration of a small dose of ketamine may be valuable to a multimodal analgesic regimen...
May 2014: Anesthesia, Essays and Researches
Amit Gupta, Kumkum Gupta, Prashant K Gupta, Nivesh Agarwal, Bhawna Rastogi
BACKGROUND: Laparoscopic cholecystectomy is performed to minimize the postoperative morbidity and early return to work. This study was planned to evaluate the efficacy and feasibility of thoracic epidural anesthesia for laparoscopic cholecystectomy, so that it can be later used as anesthetic technique in patients when general anesthesia is not feasible. MATERIALS AND METHODS: Forty-eight adult consented patients of ASA grade I and II of either sex scheduled for elective laparoscopic cholecystectomy were enrolled for thoracic epidural anesthesia with 15 ml of 0...
July 2011: Anesthesia, Essays and Researches
Yasser Mohamed Amr
AIM: This study was to identify the safety and efficacy of adding epidural N-methyl-D-aspartate receptor antagonists (ketamine) to oral gabapentin for the treatment of post spinal cord injury-related chronic pain. MATERIALS AND METHODS: Forty patients in the age range of 18-50 years with a diagnosis of neuropathic pain secondary to spinal cord injury were randomized into two equal groups. Group I received 0.2 mg/Kg of preservative-free ketamine (2 ml) single bolus epidural injection and gabapentin 300 mg three times daily...
January 2011: Anesthesia, Essays and Researches
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