Memories From the Nutlin-3-Industry Experts Who Have Become Successful
Sub-anesthetic ketamine for perioperative analgesia is an elective treatment, and a risk-benefit assessment should be done in all cases where the patient may have a relative contraindication. Table 1 Contraindications to sub-anesthetic ketamine Clinical Applications There is ample evidence that perioperative ketamine is effective for postsurgical Selleck ABT737 pain management. In 2005, Elia and Tram��r performed a systematic review of 53 randomized trials of perioperative ketamine in adults and children and reported that, in a sub-group of ten trials that examined visual analog scale (VAS), perioperative ketamine was associated with a statistically significant reduction in pain scores at 6, 12, 24, and 48 h postoperation.[12] In a Cochrane review from 2010, Bell et al. reviewed 37 randomized controlled trials of adult surgical patients who received perioperative ketamine or placebo and found that 27 of the 37 trials demonstrated that ketamine reduced analgesic requirements and/or pain scores.[23] In a sub-group of ten of these studies that measured 24-h patient-controlled analgesia (PCA) morphine, the authors concluded that perioperative ketamine reduces 24-h morphine consumption by roughly 16 mg (Elia and Tram��r report a similar number). It should be noted that the studies in both of these large systematic reviews were heterogenous with respect to ketamine dose, timing of administration, and importantly, route of administration (epidural and IV). Though there are conflicting data, neuraxial ketamine is potentially neurotoxic and is not Thymidine kinase currently recommended for the treatment of noncancer pain.[6] Furthermore, epidural and regional anesthesias are probably confounders in ketamine studies because they are typically independently effective for postoperative analgesia. In 2011, Laskowski et al. published a systematic review of 70 studies that looked at only IV ketamine for perioperative analgesia (importantly excluding all studies that used neuraxial learn more or regional anesthesia).[11] Using a random effects statistical model, the authors found that perioperative IV ketamine significantly reduced postoperative opioid consumption and increased the time to first postoperative analgesic requirement. Laskowski et al. performed a sub-group analysis and concluded that ketamine reduced opioid consumption most profoundly in upper abdominal and thoracic procedures. Ketamine was effective, although less so in orthopedic (limb and spine) and lower abdominal surgery. Opioid-sparing in ear, nose, and throat and oral surgery procedures was not significant. Furthermore, the authors found that opioid-sparing was greatest in patients with high VAS scores (70% maximum or greater) and was not beneficial with lower VAS scores (
