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1.
Acta Anaesthesiol Scand ; 65(1): 128-134, 2021 01.
Article in English | MEDLINE | ID: covidwho-1455487

ABSTRACT

BACKGROUND: Post-operative pain treatment with ketamine has been demonstrated to have post-operative opioid-sparing and anti-hyperalgesic effects. However, evidence regarding the beneficial and harmful effects and the optimal dose and timing of perioperative treatment with ketamine for patients undergoing spinal surgery is unclear. The objective of this systematic review is to assess the analgesic, serious and non-serious adverse effects of perioperative pain treatment with ketamine for patients undergoing spinal surgery. METHODS: This protocol for a systematic review is written according to The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search Embase, CENTRAL, PubMed, WHO's ICTRP, EU Clinical Trial Register and ClinicalTrials.gov to identify relevant randomised clinical trials. We will include all randomised clinical trials assessing perioperative ketamine treatment versus placebo or no intervention for patients undergoing spinal surgery. Two authors will independently screen trials for inclusion using Covidence, extract data and assess risk of bias using Cochrane's RoB tool. We will analyse data using Review Manager and Trial Sequential Analysis. Meta-analysis will be performed according to the Cochrane guidelines and results will be validated according to the eight-step procedure suggested by Jakobsen et al. We will present our primary findings in a 'summary of findings' table. We will evaluate the overall certainty of evidence using the GRADE approach. DISCUSSION: This systematic review will assess the beneficial and harmful effects of perioperative pain treatment with ketamine for patients undergoing spinal surgery and have the potential to inform best practice and advance research.


Subject(s)
Ketamine , Humans , Ketamine/therapeutic use , Meta-Analysis as Topic , Pain, Postoperative/drug therapy , Systematic Reviews as Topic
2.
Nurs Stand ; 36(9): 77-81, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1369911

ABSTRACT

Ketamine is a synthetic drug with unique properties which started to be used therapeutically in humans in the 1970s and is now widely used in all fields of nursing. Ketamine acts on the central nervous system, primarily through inhibiting N-methyl-D-aspartate receptors. However, the precise understanding of its mechanisms of action remains elusive in many respects. Ketamine is frequently used as an anaesthetic in medical and surgical procedures and as an analgesic in children and adults. It is increasingly used in mental health settings to treat depression. It has potential to be used more often in areas such as palliative care and mental health care. This article reviews the physiological and pharmacological properties of ketamine, explores its main therapeutic uses, and considers the associated implications for nursing practice.


Subject(s)
Analgesics , Anesthetics , Ketamine , Analgesics/pharmacology , Analgesics/therapeutic use , Anesthetics/pharmacology , Anesthetics/therapeutic use , Anti-Inflammatory Agents/pharmacology , Anti-Inflammatory Agents/therapeutic use , Antidepressive Agents/pharmacology , Antidepressive Agents/therapeutic use , Humans , Ketamine/pharmacology , Ketamine/therapeutic use
3.
Psychiatry Res ; 303: 114086, 2021 09.
Article in English | MEDLINE | ID: covidwho-1303645

ABSTRACT

Herein we evaluate the impact of COVID-19 restrictions on antidepressant effectiveness of intravenous (IV) ketamine in adults with treatment-resistant depression (TRD). We conducted a case series analysis of adults with TRD (n = 267) who received four ketamine infusions at an outpatient clinic in Ontario, Canada, during COVID-19 restrictions (from March 2020 - February 2021; n = 107), compared to patients who received treatment in the previous year (March 2019 - February 2020; n = 160). Both groups experienced significant and comparable improvements in depressive symptoms, suicidal ideation, and anxiety with repeated ketamine infusions. Effectiveness of IV ketamine was not attenuated during the COVID-19 period.


Subject(s)
COVID-19 , Depressive Disorder, Major , Depressive Disorder, Treatment-Resistant , Ketamine , Adult , Depression , Depressive Disorder, Major/drug therapy , Depressive Disorder, Treatment-Resistant/drug therapy , Humans , Infusions, Intravenous , Ketamine/therapeutic use , Ontario , Pandemics , SARS-CoV-2
4.
J Affect Disord ; 282: 252-254, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1065258

ABSTRACT

Ketamine's rapid antisuicidal action has gathered significant clinical interest in treatment of depression though concerns exist that its actions occur through the Opioid pathway. A recent study additionally reported that Naltrexone blocks antisuicidal effects of Ketamine suggesting that its antisuicidal effects are also due to opioid mechanisms. We present a case of treatment refractory depression with recent suicide attempt and active suicidal ideations who was on an Opioid partial agonist, Buprenorphine, for management of pain. Patient responded to a trial of IV ketamine treatment with rapid improvement in suicidal thoughts. Patient's suicidal ideations decreased after first Ketamine treatment and resolved after second treatment while maintained on Buprenorphine. Our finding shows that Buprenorphine does not block Ketamine's effects on suicidal ideations and therefore Ketamine treatment could be provided safely in controlled environment to those with substance use disorders or with chronic pain while being maintained on Buprenorphine. Additionally, our case suggests that non-Opioid mechanisms may be involved in Ketamine's antidepressant effects and its response to suicidal ideations in those on Opioid partial agonists.


Subject(s)
Buprenorphine , Depressive Disorder, Treatment-Resistant , Ketamine , Antidepressive Agents/therapeutic use , Buprenorphine/therapeutic use , Depressive Disorder, Treatment-Resistant/drug therapy , Humans , Ketamine/therapeutic use , Suicidal Ideation
5.
J Korean Med Sci ; 36(4): e28, 2021 Jan 25.
Article in English | MEDLINE | ID: covidwho-1048950

ABSTRACT

Hospitalized coronavirus disease 2019 (COVID-19)-infected patients suffer from both physical impairments and mental stress. Respiratory insufficiency and cardiovascular disturbances require most of the intensive care interventions, but they are also accompanied by depressive conditions, sadness and fear of dying. Sedatives are mostly respiratory and cardiovascular depressants and do not provide resistance to the pro-inflammatory burst induced by the virus. Ketamine is a unique and safe drug that enables well-controlled sedation and anesthesia, attenuates depression and mitigates suicidal thoughts, without depressing respiratory or cardiovascular mechanics. This brief communication highlights the benefits potentially provided by ketamine to patients hospitalized for COVID-19 infection.


Subject(s)
COVID-19/drug therapy , COVID-19/psychology , Depression/drug therapy , Ketamine/therapeutic use , Stress, Psychological/drug therapy , Anesthesia , Anxiety/drug therapy , Critical Care , Depression/complications , Hemodynamics , Hospitalization , Humans , Hypnotics and Sedatives , Immune System , Respiratory Insufficiency , Stress, Psychological/complications , Suicidal Ideation , Treatment Outcome
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