Search History:
1. EMBASE, MEDLINE; ketamine.ti,ab; 16339 results.
2. MEDLINE; exp ASTHMA, EXERCISE-INDUCED/ OR exp ASTHMA/; 84203 results.
3. MEDLINE; exp STATUS ASTHMATICUS/; 904 results.
4. MEDLINE; exp ASTHMA/ OR exp STATUS ASTHMATICUS/; 84203 results.
5. MEDLINE; exp KETAMINE/; 7078 results.
6. MEDLINE; asthma.ti,ab; 76509 results.
7. MEDLINE; ketamine.ti,ab; 8784 results.
8. MEDLINE; 5 OR 7; 10001 results.
9. MEDLINE; 2 OR 3 OR 4 OR 6; 100193 results.
10. MEDLINE; 8 AND 9; 66 results.
11. MEDLINE; ketamine.ti [Limit to: Humans and English Language]; 1867 results.
Title: Ketamine to avoid mechanical ventilation in severe pediatric asthma.
Citation: Journal of Emergency Medicine, February 2006, vol./is. 30/2(163-6), 0736-4679
Author(s): Denmark TK; Crane HA; Brown L
Language: English
Abstract: Children experiencing severe asthma exacerbations may deteriorate to respiratory failure requiring endotracheal intubation and mechanical ventilation. Mechanical ventilation is often life saving in this setting, but also exposes the asthmatic child to substantial iatrogenic risk. We present two cases of severe asthma exacerbations in prepubertal children for whom the administration of a bolus of intravenous ketamine followed by a continuous infusion of a relatively large dose of ketamine led to prompt improvement, obviating the need for mechanical ventilation. These cases suggest that for children experiencing severe asthma exacerbations, intravenous ketamine may be an effective temporizing measure to avoid exposing these children to the risks associated with mechanical ventilation.
Publication Type: Case Reports; Journal Article
Subject Headings:
*Anesthetics, Dissociative/tu [Therapeutic Use]
*Asthma/dt [Drug Therapy]
Child
Child, Preschool
Humans
Infusions, Intravenous
*Ketamine/tu [Therapeutic Use]
Male
Respiration, Artificial
Source: MEDLINE
Title: The efficacy of ketamine in pediatric emergency department patients who present with acute severe asthma.
Citation: Annals of Emergency Medicine, July 2005, vol./is. 46/1(43-50), 1097-6760
Author(s): Allen JY; Macias CG
Language: English
Abstract: STUDY OBJECTIVE: We determine whether a continuous infusion of ketamine can decrease the severity of a moderately severe acute asthma exacerbation by a clinically significant 2 points using a 15-point Pulmonary Index scoring scale. METHODS: A double-blinded, randomized, placebo-controlled trial was performed to evaluate patients aged 2 to 18 years who presented to a pediatric emergency department with an acute asthma exacerbation. Exclusion criteria included temperature greater than 39 degrees C (102 degrees F), focal infiltrate on radiograph, or any glucocorticoid use in the last 72 hours. Eligible patients received 3 treatments with albuterol, ipratropium bromide, and a dose of oral or parenteral glucocorticoids. If the Pulmonary Index score remained 8 to 14, enrollment proceeded. All enrolled patients received continuous nebulized albuterol at 10 mg/hour and were randomized to receive an intravenous bolus of 0.2 mg/kg of ketamine, followed by a 2-hour ketamine infusion at 0.5 mg/kg per hour or an equal-volume regimen with normal-saline placebo. A Pulmonary Index score was performed on patients at 0, 30, 60, 90, and 120 minutes. RESULTS: Sixty-eight patients were enrolled, with 33 randomized to the ketamine infusion and 35 randomized to placebo. Mean ages of patients enrolled, chronic severity of asthma, and duration of symptoms before presentation were similar between groups. At enrollment, the mean Pulmonary Index score in the placebo group was 10.3+/-1.1 versus 10.5+/-1.5 for the ketamine group (difference of means 0.2; 95% confidence interval [CI] -0.5 to 0.8). Sixty-two patients completed the entire 2-hour infusion protocol. No significant difference between groups was seen in rate of improvement in the Pulmonary Index score at completion. The mean decrease in the Pulmonary Index scores at the end of the infusion was 3.6+/-1.3 in the placebo group versus 3.2+/-2.0 in the ketamine group (difference of means 0.4; 95% CI -0.4 to 1.3). No short-term adverse effects necessitating discontinuation of the infusion or adverse behavioral impacts at 48 hours after discharge were noted. CONCLUSION: We conclude that ketamine given at 0.2 mg/kg followed by an infusion of 0.5 mg/kg per hour for 2 hours provided no incremental benefit to standard therapy in this cohort of children with a moderately severe asthma exacerbation.
Publication Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
Subject Headings:
Adolescent
*Anesthetics, Dissociative/ad [Administration & Dosage]
Asthma/cl [Classification]
Asthma/di [Diagnosis]
*Asthma/dt [Drug Therapy]
Bronchodilator Agents/ad [Administration & Dosage]
Child
Child, Preschool
Double-Blind Method
Emergency Medicine/mt [Methods]
Female
Follow-Up Studies
Hospitalization
Humans
Infusions, Parenteral
Injections, Intravenous
*Ketamine/ad [Administration & Dosage]
Male
Outcome and Process Assessment (Health Care)
Pediatrics/mt [Methods]
Treatment Outcome
Source: MEDLINE
Title: Emergency department use of ketamine in pediatric status asthmaticus.
Citation: Journal of Asthma, December 2001, vol./is. 38/8(657-64), 0277-0903
Author(s): Petrillo TM; Fortenberry JD; Linzer JF; Simon HK
Language: English
Abstract: The objective of this study was to evaluate the effects of adding ketamine to standard emergency department (ED) therapy for patients with status asthmaticus. This was a prospective observational study. Ten patients with an acute exacerbation of asthma who were unresponsive to standard therapy were enrolled in the ED. Upon enrollment, children received ketamine at a loading dose of 1 mg/kg intravenously (i.v.), followed by a continuous infusion of 0.75 mg/kg/hr (12.5 microg/kg/min) for 1 hr. Clinical asthma score (CAS), vital signs, and peak expiratory flow (PEF) measurements were obtained prior to ketamine administration, within 10 min after ketamine administration was completed, and 1 hr after infusion. Median CAS on ED arrival was 15 (range 7-23) and did not significantly change immediately prior to infusion of ketamine (median 14, range 8-21). Median CAS decreased to 10.5 immediately after infusion and to 9.51 hr post ketamine infusion (37% reduction, p < 0.05 by ANOVA vs. preketamine CAS). Median respiratory rate (RR) also decreased from 39 prior to ketamine to 30 immediately following ketamine administration (25% decrease vs. preketamine; p < 0.05). Oxygen saturation significantly improved after ketamine infusion, although 5 patients remained on oxygen. Median PEF improved after infusion, but was not statistically significant. Four patients experienced mild side effects including mild hallucinations, diffuse flushing, and moderate hypertension. Side effects resolved with benzodiazepines or with discontinuation of the infusion. Addition of ketamine to standard therapy was associated with improved indices of acute asthma severity. Side effects were transitory and comparable to previous studies. However, a double-blinded randomized controlled trial needs to be conducted to determine if improvement is attributable to the addition of ketamine to standard asthma therapy.
Publication Type: Journal Article
Subject Headings:
Bronchodilator Agents/ad [Administration & Dosage]
*Bronchodilator Agents/tu [Therapeutic Use]
Child
*Emergency Service, Hospital
Female
Humans
Ketamine/ad [Administration & Dosage]
*Ketamine/tu [Therapeutic Use]
Male
Prospective Studies
Severity of Illness Index
*Status Asthmaticus/dt [Drug Therapy]
Time Factors
Source: MEDLINE
Title: Does ketamine have a role in managing severe exacerbation of asthma in adults?.
Citation: Pharmacotherapy, September 2001, vol./is. 21/9(1100-6), 0277-0008
Author(s): Lau TT; Zed PJ
Language: English
Abstract: OBJECTIVE: To evaluate the role of ketamine in management of severe exacerbation of asthma in adults. METHODS: Qualitative systematic search using MEDLINE (January 1966-September 2000), EMBASE (January 1988-September 2000), and the Cochrane Database of Systematic Reviews (Issue 2, 2000). RESULTS: One prospective, randomized, double-blind, placebo-controlled trial and five case reports were retrieved. In the clinical trial, low-dosage ketamine as an adjunct to standard therapy offered no benefit in improving outcomes in nonventilated patients. In the case reports, all patients with refractory severe exacerbation of asthma requiring mechanical ventilation appeared to receive some benefit from ketamine, with alleviation of bronchospasm and improved oxygenation. Adverse effects included dysphoria, hallucinations, and increased pulmonary secretions. CONCLUSION: Limited evidence is available in the literature to support administration of ketamine in severe exacerbation of asthma. Although a few cases suggest possible benefit from ketamine, it should not be considered until controlled clinical trials demonstrate that benefits outweigh risks for patients for whom other standard therapies failed.
Publication Type: Journal Article; Review
Subject Headings:
Adult
*Asthma/co [Complications]
*Asthma/dt [Drug Therapy]
Asthma/pp [Physiopathology]
*Excitatory Amino Acid Antagonists/tu [Therapeutic Use]
Humans
*Ketamine/tu [Therapeutic Use]
Randomized Controlled Trials as Topic
Source: MEDLINE
Title: Randomized, double-blind, placebo-controlled trial of intravenous ketamine in acute asthma.
Citation: Annals of Emergency Medicine, February 1996, vol./is. 27/2(170-5), 0196-0644
Author(s): Howton JC; Rose J; Duffy S; Zoltanski T; Levitt MA
Language: English
Abstract: STUDY OBJECTIVE: To evaluate the efficacy of IV ketamine in the management of acute, severe asthma. METHODS: This prospective, randomized, double-blind, placebo-controlled clinical trial at an urban teaching hospital emergency department involved 53 consecutive patients aged 18 to 65 with a clinical diagnosis of acute asthmatic exacerbation and a peak expiratory flow of less than 40% of the predicted value after three albuterol nebulizer treatments. All patients received oxygen, continuous nebulized albuterol, and methylprednisolone sodium succinate (Solu-Medrol). Patients then received either ketamine hydrochloride in a bolus of .2 mg/kg followed by IV infusion of .5 mg/kg per hour for 3 hours or a placebo bolus and infusion for 3 hours. Because of the occurrence of dysphoric reactions, the bolus dose was lowered to .1 mg/kg after the first 9 patients; the infusion dose was kept the same. RESULTS: The first nine patients were eliminated from analysis. Repeated ANOVA testing on the remaining 44 patients determined significant improvements over time within each treatment group in peak flow (F=3.637, P=.004). Borg score (F=22.959, P=.001), respiratory rate (F=8.11, P=.0001). and 1-second forced expiratory volume (F=9.076, P=.001). However, no difference could be detected over time between treatment groups (power, 80%). Patients receiving ketamine gave the treatment a rating of 4.3 on a scale of 1 to 5, whereas those receiving placebo scored their treatment 3.7 (P=.0285). The hospital admission rate was not different between treatment groups (P=.1088). CONCLUSION: IV ketamine at a dose low enough to avoid dysphoric reactions demonstrated no increased bronchodilatory effect compared with standard therapy in treating exacerbations of asthma in the ED. Although there was a slight increase in satisfaction in the ketamine group, no clinical benefit in terms of hospital admission rate was noted.
Publication Type: Clinical Trial; Journal Article; Randomized Controlled Trial
Subject Headings:
Adolescent
Adult
Aged
Analysis of Variance
Anesthetics, Dissociative/ad [Administration & Dosage]
*Anesthetics, Dissociative/tu [Therapeutic Use]
*Asthma/dt [Drug Therapy]
Asthma/pp [Physiopathology]
Bronchodilator Agents/ad [Administration & Dosage]
Double-Blind Method
Drug Therapy, Combination
Female
Forced Expiratory Volume/de [Drug Effects]
Hemodynamics/de [Drug Effects]
Humans
Infusions, Intravenous
Ketamine/ad [Administration & Dosage]
*Ketamine/tu [Therapeutic Use]
Male
Middle Aged
Peak Expiratory Flow Rate/de [Drug Effects]
Prospective Studies
Source: MEDLINE