Trending Articles
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Paediatric anaesthesia · Oct 2019
The Effect of Ketamine on Emergence Agitation in Children: A Systematic Review and Meta-analysis.
Although there is some evidence that ketamine may reduce emergence delirium in children, it is generally low quality and inconsistent, and practice change is not recommended.
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Neuron-specific enolase (NSE) is an acknowledged marker of traumatic brain injury. Several markers originally considered reliable in the setting of traumatic brain injury have been challenged after having been studied more extensively. The aim of our experimental study was to determine whether NSE is a reliable marker of traumatic brain injury early after trauma. ⋯ During femur fracture, MAP remained at a level that is not associated with shock in rats. Our findings show for the first time that NSE increases after hemorrhagic shock as well as after femur fracture without hemorrhagic shock in rats. From a clinical point of view, these findings indicate that NSE cannot be considered a reliable marker of traumatic brain injury early after trauma in cases associated with hemorrhagic shock and/or femur fracture.
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Experts consider health information technology key to improving efficiency and quality of health care. ⋯ Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.
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Randomized Controlled Trial
Ketamine infusion for 96 hr after thoracotomy: Effects on acute and persistent pain.
Why is this significant?
This is the first randomised controlled trial looking at the impact of perioperative ketamine on persistent post-surgical (PPS) pain 1 year after thoracic surgery. Thoracotomy is associated with both severe and a high incidence (up to 50% at 6 months) chronic pain.
Ketamine has important analgesic properties through NMDA blockade, and has been long thought (hoped) that via this it may modify chronic post-surgical pain. Nonetheless, many studies have been unable to show a benefit for ketamine in reducing PPS pain.
What did they show?
Chumbley et al. ran ketamine infusions at 0.1 mg/kg/hour for 96 hours in patients undergoing thoracotomy, starting with a 0.1 mg/kg bolus 10 minutes before surgery. Patients also received either an epidural or paravertebral infusion for post-operative analgesia.
Although there were small differences in acute pain (notably the ketamine group used less PCA morphine) there was no difference in persistent post-surgical pain at 12 months.
Bottom-line
The evidence continues to mount against perioperative ketamine, suggesting it does not reduce persistent post-surgical pain, not-withstanding its acute analgesia benefits. Await results of the ROCKet trial (Reduction Of Chronic Post-surgical Pain with Ketamine) to provide greater clarity...
An afterthought
Notably, the researchers did demonstrate a dramatically lower incidence of PPS pain than for similar studies (27%, 18%, 13% at 3, 6, 12 months) across both the ketamine and placebo group. This suggests that either the study participants were not representative of the typical thoracotomy patient (unlikely), or other care associated with the study had a beneficial effect on reducing PPS – perhaps even via a Hawthorne-like effect.
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