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- ItemAcesso aberto (Open Access)Avaliação da S(+) cetamina por via oral associada à morfina no tratamento da dor oncológica(Sociedade Brasileira de Anestesiologia, 2007-02-01) Ishizuka, Pedro [UNIFESP]; Garcia, João Batista Santos [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Issy, Adriana Machado [UNIFESP]; Mülich, Sílvia Letícia [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Maranhão; UFMA Instituto Maranhense de Oncologia e do Ambulatório de Dor Serviço de DorBACKGROUND AND OBJECTIVES: Morphine is used frequently to treat oncologic pain. However, tolerance may develop with prolonged use. The association of a NMDA receptor antagonist may reduce or delay the onset of tolerance. S(+) ketamine seems to be more potent and with fewer side effects. The aim of this study was to evaluate the association of S(+) ketamine and morphine in the treatment of oncologic pain. METHODS: Thirty patients, randomly divided in two groups, participated in this double-blind study. Patients in G1 received 10 mg of morphine PO every 6 hours and 10 mg of S(+) ketamine PO every 8 hours. Patients in G2 received 10 mg of morphine PO every 6 hours and placebo PO every 8 hours. The dose of morphine was adjusted by 5 mg increments whenever necessary. Pain severity was evaluated through a verbal scale. RESULTS: The percentage of no pain and mild pain was similar in both groups (G1 = 0 and G2 = 0 at M0; G1 = 22.2 and G2 = 53.8 at M1; G1 = 22.2 and G2 = 61.5 at M2; G1 = 44.6 and G2 = 61.5 at M3; and G1 = 44.5 and G2 = 53.8 at M4); Chi-square test. The percentage of moderate relief and complete relief was similar in both groups (G1 = 33.4 and G2 = 53.9 after one week; G1 = 44.4 and G2 = 69.2 after two weeks; G1 = 66.6 and G2 = 69.2 after three weeks; and G1 = 55.6 and G2 = 53.9 after four weeks); Chi-square test. The need to increase the dose of morphine was also similar in both groups (G1 = 2.22 and G2 = 2.15); Mann-Whitney test. CONCLUSIONS: We did not observe an increase on the analgesic effects of morphine with the association of 10 mg of S(+) ketamine PO in the treatment of oncologic pain.
- ItemAcesso aberto (Open Access)Avaliação do efeito da s(+)cetamina associada a remifentanila na dor e hiperalgesia pós-operatória em colecistectomia videolaparoscópica: estudo randomizado, duplo-cego(Universidade Federal de São Paulo (UNIFESP), 2014-11-26) Leal, Plinio da Cunha [UNIFESP]; Sakata, Rioko Kimiko [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The use of remifentanil results in short-term analgesic effect and is related to the phenomenon of opioid induced hyperalgesia. Some mechanisms have been proposed to explain the phenomenon of hyperalgesia, including the activation of N-methyl-Daspartate (NMDA). The association of blocking NMDA receptor, S(+)ketamine, to remifentanil can promote better analgesia and longer duration. The aim of this study was to determine if the association of ketamine to remifentanil promotes better postoperative analgesia and reduces postoperative hyperalgesia, evaluated with algometer, monofilaments and cytokine dosage. Methods: The study was a prospective, randomized, double-blind clinical trial, including 60 patients ≥ 18 years of age submitted to laparoscopic cholecystectomy. Anesthesia was induced with remifentanil (1 μg.Kg-1), propofol and atracurium. Patients in G1 received remifentanil (0.4 μg.Kg-1.min-1) and ketamine (5 μg.Kg-1.min-1); patients in G2 received remifentanil (0.4 μg.Kg-1.min-1) and normal saline. The dose was increased or decreased as needed. The infusion of the solutions was continued until skin closure. Postoperative pain was treated with morphine PCA. The parameters evaluated were: time to first PCA complementation; total morphine consumption in 24 h; intensity of postoperative pain; hyperalgesia using algometer and monofilaments; allodynia using soft brush; extent of hyperalgesia using a 300g monofilament; and inflammatory respose through interleukin 6, 8 and 10 dosage. Adverse effects were noted. Results: There was no difference in demographic characteristics between the groups, as well as the duration of surgery, anesthesia and time to awakening. There was no statistically significant difference in time for the morphine dose requirement between G1 (18 min) and G2 (15 min), or in pain intensity at the evaluation period. There was no statistically significant difference between groups in the dose of remifentanil, as well as the total dose of morphine consumption (27.4 ± 18.3 mg for G1 and 27.7 ± 12.9 mg for G2). There was a statistically significant difference in hyperalgesia evaluated with monofilaments in the thenar eminence of the hand 24 hours after surgery (p = 0.019, student's t test), with a lower sensitivity threshold seen in patients in group 2. No statistically significant difference was observed in hyperalgesia evaluated with algometer, allodynia with soft brush or in the extent of hyperalgesia. There was no statistical difference in interleukin 6, 8 and 10 dosage between the groups at the evaluation times. Regarding adverse effects, there was a statistically significant difference in visual changes, sedation and vomiting, with a higher rate in G1. Conclusions: The association of ketamine (5 μg.kg- 1.min-1) to remifentanil for laparoscopic cholecystectomy did not change postoperative pain intensity, time to first supplementary analgesia or total dose of morphine in 24 hours, although it was promoted a reduction in hyperalgesia evaluated using monifilaments in the thenar eminence of the hand 24 hours after surgery; there was no statistical difference in hyperalgesia seen using a algometer, allodynia using a soft brush and in IL-6, IL-8 e IL-10 dosage
- ItemAcesso aberto (Open Access)Effects of sodium nitroprusside in the prevention of schizophrenia-like symptoms induced by ketamine - A translational double-blind study(Univ Sao Paulo, Inst Psiquiatria, 2017) Rezende, Tatiana M. N.; Maia-de-Oliveira, Joao Paulo; Kandratavicius, Ludmyla; Machado-de-Sousa, Joao Paulo; Abrao, Joao; Prado, Daniel Almeida; Bressan, Rodrigo A. [UNIFESP]; Lacerda, Acioly L. T. [UNIFESP]; Zuardi, Antonio W.; Baker, Glen B.; Dursun, Serdar M.; Hallak, Jaime E. C.Background: Recent evidence has shown improvements in schizophrenia symptoms after the infusion of sodium nitroprusside (SNP), a nitric oxide (NO) donor. In the rat model of schizophrenia using ketamine injection, pretreatment with SNP seems to prevent behavioral changes associated with positive symptoms for up to one week. Objective: We investigated whether SNP would have preventative effects on psychogenic symptoms induced by ketamine in healthy subjects. Methods: Healthy subjects (N = 38) were assigned to distinct groups that received SNP in different doses (0.15, 0.25, and 0.5 mcg/kg/min). First, participants received an infusion of SNP or placebo over 75 minutes. After 10 minutes, they were injected for 1 minute with a bolus of 0.26 mg/kg of ketamine and a maintenance dose was started 5 minutes later, with 0.25 mg/kg/h of ketamine for 50 minutes. Results: Ketamine-induced psychopathological alterations induced were reduced by SNP, as assessed with the Brief Psychological Rating Scale. Scores in the objective subscale of the Clinician-Administered Dissociative States Scale were also lower in SNP sessions compared to placebo. SNP had protective effects against deterioration in facial emotion and identity recognition tasks induced by ketamine. Discussion: Our findings support the view that SNP has preventative properties against psychotic manifestations.
- ItemSomente MetadadadosHippocampal volume and the rapid antidepressant effect of ketamine(Sage Publications Ltd, 2015-05-01) Abdallah, Chadi G.; Salas, Ramiro; Jackowski, Andrea [UNIFESP]; Baldwin, Philip; Sato, Joao R. [UNIFESP]; Mathew, Sanjay J.; Natl Ctr Posttraumat Stress Disorder PtSD; Yale Univ; Baylor Coll Med; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do ABC (UFABC); Michael E Debakey Vet Adm VA Med CtrAccumulating evidence underscores the utility of ketamine in treating severely treatment-resistant depressed patients. We investigated the relationship between the rapid antidepressant effects of ketamine and hippocampal volume, a biomarker of antidepressant treatment outcome. We gave 16 medication-free, major depressive disorder (MDD) patients a single, sub-anesthetic dose infusion of ketamine (0.5 mg/kg, over 40 min). We assessed depression severity pre-treatment, and at 24 h post-treatment, with the Montgomery-angstrom sberg Depression Rating Scale (MADRS). Prior to treatment, patients underwent magnetic resonance imaging (MRI) to estimate their hippocampal volume: We obtained viable MRI data in 13 patients. Delta MADRS (post- minus pre-treatment) was significantly correlated with the pre-treatment volumes of the left hippocampus (r = 0.66; p = 0.01), but not the right hippocampus (r = 0.49; p = 0.09). the correlation between delta MADRS and the left hippocampus remained high (r > 0.6; p = 0.13), after controlling for several demographic and clinical variables, although the p value increased due to the reduced degree of freedom (df = 5). Ketamine exerts enhanced antidepressant effects in patients with a relatively smaller hippocampus, a patient population that has been repeatedly shown to be refractory to traditional antidepressants.
- ItemSomente MetadadadosProcedural sedation for insertion of central venous catheters in children: comparison of midazolam/fentanyl with midazolam/ketamine(Blackwell Publishing, 2007-04-01) Silva, Paulo Sergio Lucas da; Iglesias, Simone Brasil de Oliveira [UNIFESP]; Aguiar, Vania Euzebio; Carvalho, Werther Brunow de; Universidade Federal de São Paulo (UNIFESP)Background: There is a lack of studies evaluating procedural sedation for insertion of central venous catheters (CVC) in pediatric patients in emergency departments or pediatric intensive care units (PICU). This study was designed to evaluate whether there is a difference in the total sedation time for CVC insertion in nonintubated children receiving two sedation regimens.Methods: Patients were prospectively randomized to receive either midazolam/fentanyl (M/F) or midazolam/ketamine (M/K) i.v. the Children's Hospital of Wiscosin Sedation Scale was used to score the sedation level.Results: Fifty seven patients were studied (28 M/F and 29 M/K). Group M/F received midazolam (0.24 +/- 0.11 mg.kg(-1)) and fentanyl (1.68 +/- 0.83 mu g.kg(-1)) and group M/K received midazolam (0.26 +/- 0.09 mg.kg(-1)) and ketamine (1.40 +/- 0.72 mg.kg(-1)). the groups were similar in age, weight, risk classification time and sedation level. Median total sedation times for M/F and M/K were 97 vs 105 min, respectively (P = 0.67). Minor complications occurred in 3.5% (M/F) vs 20.7% (M/K) (P = 0.03). M/F promoted a greater reduction in respiratory rate (P = 0.005).Conclusions: in this study of nonventilated children in PICU undergoing central line placement, M/F and M/K provided a clinically comparable total sedation time. However, the M/K sedation regimen was associated with a higher rate of minor complications. A longer period of study is required to assess the efficacy and safety of these sedative agents for PICU procedures in nonintubated children.
- ItemSomente MetadadadosUse of Ketofol for procedural sedation and analgesia in children with hematological diseases(Wiley-Blackwell, 2011-02-01) Lucas da Silva, Paulo Sergio; Aguiar, Vania Euzebio de; Waisberg, Daniel Reis; Augusto Passos, Roselene M.; Flor Park, Miriam Veronica; Hosp Brigadeiro; Universidade Federal de São Paulo (UNIFESP)Background:The aim of this study was to evaluate the effectiveness and safety of intravenous ketamine-propofol admixture (ketofol) in the same syringe for procedural sedation and analgesia in children undergoing bone marrow aspiration.Methods:This was a prospective, observational pilot study. Patients aged between 4 and 12 years requiring sedation for bone marrow aspiration were included. Ketofol (1 : 1 mixture of ketamine 10 mg/mL and propofol 10 mg/mL) was given intravenously in 0.5 mg/kg aliquots each with a 1-min interval and titrated to reach sedation levels of 3 or 4 (Ramsay score). the primary outcome was patient satisfaction with the degree of sedation. Secondary outcomes included injection pain, total sedation time, recovery time, hemodynamic and respiratory parameters, and adverse events.Results:A total of 20 patients were enrolled in the study. the median total dose of ketofol administered was 1.25 mg/kg each of propofol and ketamine (95%CI 0.77-2 mg/kg). the median score on the visual analog scale was 0 (extremely comfortable) (0-1.5; 95%CI 0.2-2.2). Median recovery time was 23 min (20.5-28 min; 95%CI 17.1-51.2). the incidence of injection pain was 2/20. Two patients had transient diplopia and one child reported dreams. No patients had hypotension, vomiting or required airway intervention.Conclusion:Ketofol provided effective sedation, which was reflected in the high degree of satisfaction recorded by children requiring procedural sedation and analgesia for bone marrow aspiration. We also observed rapid recovery and no clinically significant complications. A large number of patients is required to evaluate and validate these findings.