PURPOSE: To compare the efficacy of ketamine between intranasal (IN) administration and intramuscular (IM) injection for pediatric procedural sedation and analgesia (PPSA). METHODS: A prospective study was conducted during 3 months. Ketamine was given by IN or IM route before primary repair of facial laceration for procedural sedation. The administration dose was 8 mg/kg for IN and 4 mg/kg for IM. We evaluated resistance scale on administration, sedation scale, satisfaction of physician and parents. RESULTS: One hundred children were enrolled into this study. IN administration was given to 50 children, and IM injection to 50 children each. In the IN group, 75%(36 of 50) showed severe resistance, whereas only 34%(17 of 50) showed severe resistance and 50%(25 of 50) showed mild resistance in IM group. Successful rate of sedation after initial administration was 82%(41 of 50) in IM group and 34% in IN group. Satisfaction of physicians and parents was high in IM injection group. CONCLUSION: Intranasal administration of Ketamine is less effective and provides lower satisfaction than intramuscular injection for procedural sedation of pediatric patients in the emergency department.
Administration, Intranasal ; Analgesia ; Child ; Conscious Sedation ; Emergencies ; Humans ; Injections, Intramuscular ; Ketamine ; Lacerations ; Parents ; Prospective Studies

Pediatric caudal anesthesia was done in 50 infants and children under 10 years of age, who were to undergo surgery of inguinal region. All cases were given 10mg/kg body weigh t of 1% lidocaine solution with epinephrine 1:200,000. The results were as follows: 1) Pediatric caudal anesthesia was simple, easy and reliable in technique. 2) Additional intravenous administration of Ketamine or pentothal sodium was needed. i.e., to provide a more cooperative state. 3) Anesthetic effect was judged very Excellent. 4) Cardiovascular and respiratory changes were minimal. Author's came to conclusion that caudal anesthesia for pediatric inguinal region surgery in reliable, simple in technique, favorable to surgeon, and is considered to be a good technique for pediatric anesthesia.
Administration, Intravenous ; Anesthesia ; Anesthesia, Caudal* ; Anesthetics ; Child ; Epinephrine ; Humans ; Infant ; Ketamine ; Lidocaine ; Sodium ; Thiopental

Ketamine produces an increase in the heart rate and blood pressure, but the precise mechanism is controversial. In order to obtain inslight into the mechanism by observing the influence of nitroglycerin (NTG) on the ketamine effect, ketamine was administered intravenously following sublingual administration of nitroglycerin in conscious patients. The results were as follows: 1) In the ketamine(2mg/kg) group(n=15), the heart rate and blood pressure increased significantly by as much as 25%. 2) In the nitroglycerin(1.2mg) group(n=12), the heart rate increased, but blood pressure decreased from 5 minutes after administration. 3) In the group which received ketamine(2mg/kg) 5min. after NTG(1.2mg)(N=15), the heart rate did not change, but the blood pressure increased significantly without attenuation by nitroglycerin. From the above results, it is suggested that in the ketamine effect control mechanism may also be participated in addition ot the peripheral mechanism involving norepinephrine release.
Administration, Sublingual ; Blood Pressure* ; Heart Rate* ; Heart* ; Humans ; Ketamine* ; Nitroglycerin* ; Norepinephrine

Techniques of total intravenous anaesthesia with ketamine and continuous epidural block are compared with the conventional method of using halothane, nitrous oxide and relaxant. Both ketamine and epidural techniques were associated with minimal cardiovascular disturbances, low blood loss and better quality of anaesthesia and recovery scores. The usual psychomimetic effect associated with ketamine administration was observed in only one patient. Further experience of total intravenous ketamine anaesthesia with adjunctive use of fentanyl to attenuate cardiovascular effects and midazolam for the pyschomimetic effect can further refine the technique. Cerebral function monitoring, if possible, will allow correlation of depth of anaesthesia with drug dosage and can ensure appropriate anaesthetic depth and recovery.
Adult ; Anesthesia - standards ; Anesthesia, Intravenous ; Humans ; Ketamine - administration & ; dosage ; Papua New Guinea

OBJECTIVETo summarize the anesthetic management in fetal lamb cardiac bypass.

METHODSFive ewes at 120-140 days of gestation were anesthetized intramuscularly with katamine hydrochloride, intubated and ventilated with a respirator. Anesthesia was maintained with fentanyl and vecuronium. Lactated Ringer's solution and magnesium sulfate were infused to maintain the mean blood pressure (MAP) over 70 mmHg and uterine relaxation. The fetal lambs received anesthesia with fentanyl and vecuronium intramuscularly via the uterine wall. Fetal cardiac bypass was established with pulmonary artery and right atrium cannulation, lasting for 30 min. The hemodynamic and blood gas data of the ewes and fetal lambs were recorded before bypass, at 30 min during bypass, and at 1 and 2 h after cessation of bypass. The pulse index of the umbilical artery (PIua) and the ewe's uterine artery (PIeu) were monitored simultaneously.

RESULTSThe MAP and heart rate (HR) of the fetus remained normal during the anesthesia. PIua increased significantly after cessation of bypass (P<0.05). Although the fetal oxygen tension in the axillary artery remained normal, the fetal lambs showed hypercarbia and acidosis after cessation of bypass (P<0.05). The maternal MAP and HR remained normal. The PIeu decreased significantly during bypass (P<0.05) and recovered the normal level after cessation of bypass. The arterial blood gas of the ewes was normal during the experiment.

CONCLUSIONMaintaining high hemodynamics in the ewes, application of uterine relaxation and intensive care during anesthesia are crucial in anesthetic management of cardiac bypass in fetal lambs.

Anesthetics, Dissociative ; Animals ; Cardiopulmonary Bypass ; methods ; Female ; Fentanyl ; administration & dosage ; Fetal Heart ; surgery ; Goats ; surgery ; Ketamine ; administration & dosage ; Pregnancy ; Vecuronium Bromide ; administration & dosage

BACKGROUND: Postoperative pain control in children is an important problem for management but it was treated negligently. In the past, the pain was undertreated in children, even more in infant. In recent years, the importance of the pain control in children was emphasized but not enough, yet. This study was designed to evaluate the propriety of intraoperative intravenous medication technique and effectiveness of the fentanyl, ketorolac and ketamine for pain control following inguinal herniorrhaphy in pediatric patients. METHODS: Eighty children for inguinal herniorrhaphy under general anesthesia were divided into four groups. Group I received no analgesics as a control. Group II, III and IV were received intravenous fentanyl 1microgram/kg, ketorolac 1 mg/kg and ketamine 1 mg/kg respectively. Fentanyl and ketolorac were injected intravenously during the induction of anesthesia and ketamine was injected at the entrance of operating room. Emergence time and the degree of pain was evaluated. RESULTS: Our result showed that group II and group III had a lower pain score than that of the control group at the 5 min, 10 min, 20 min and 30 min in the recovery room (P <0.05), but no significant differences were found between the group I and group IV. The time interval from the end of operation to extubation was prolonged in the group II compared to the control group (P <0.05). But no significant differences were found between the three groups. CONCLUSIONS: We suggest that intravenous administration of analgesics has the propriety of the control of postinguinal herniorraphy pain in children. Intravenous administration of fentanyl 1microgram/kg and ketorolac 1 mg/kg during induction would be an easy, simple and effective means for relieving postinguinal herniorrhaphy pain in recovery room.
Administration, Intravenous ; Analgesics ; Anesthesia ; Anesthesia, General ; Child* ; Fentanyl ; Herniorrhaphy* ; Humans ; Infant ; Ketamine ; Ketorolac ; Operating Rooms ; Pain, Postoperative ; Recovery Room

CI-581(a phencyclidine derivative), a new potent, short-acting nonbarbiturate was administered to 101 patients, ranging in age from 2 months to 68 years, either intravenously, intramuscularly, or by a combination of the two routes. An intravenous dose of 1 to 2 mg per kg of body weight produced surgical anesthesia within 30 seconds, and adequate operating condition lasted for 5 to 20 minutes. With the onset of anesthesia, eyes usually opened and extremities became relaxed. However, pharyngeal and laryngeal reflexes remained active, and airway remained patent without benefit of manual support or the insertion of a mechanical airway. The pulse rate usually increased and the blood pressure rose sometimes to undesirable levels following intravenous administration, To achieve surgical anesthesia by intramuscular route a dose of 5 to 10 mg per kg was required. Surgical anesthesia developed in 3 to 5 minutes and lasted for 20 to 30 minutes. Some of the patients remembered the experience of dream which was of colorful and cheerful nature. There was no serious postoperative complications. CI-581 seemed useful to produce anesthesia for short procedures particularly in infants and children with intramuscular administration.
Administration, Intravenous ; Anesthesia ; Blood Pressure ; Body Weight ; Child ; Dreams ; Extremities ; Heart Rate ; Humans ; Infant ; Ketamine* ; Phencyclidine ; Postoperative Complications ; Reflex

PURPOSE: This study was performed to evaluate the pre-emptive analgesic effects of a small dose of intravenous ketamine on postoperative pain in patients undergoing a hysterectomy. METHOD: Sixty patients undergoing a hystrectomy under general anesthesia were randomly allocated to 2 groups. The experimental group(30 patients) received 0.3mg/kg of ketamine after induction of anesthesia, approximately 5 min prior to surgery, but the control group(30 patients)did not receive ketamine. Data was collected in a double-blind manner from April 1st, to October 30th, 2004. Postoperatively, the patients used a patient-controlled analgesia(PCA) pump. Blood pressure, pulse rate, pain, anxiety, count of times pressing the PCA button, administeration of additional analgesics and side effects of ketamine were measured at 1 hour, 3 hours, 6 hours and 24 hours after the operation. RESULT: There were no statistical differences in blood pressure, pulse rate, pain and anxiety between the experimental and control groups. There were statistical differences in blood pressure, pulse rate, pain and anxiety during the 24 hours postoperatively. In the experimental group, the number of times pressing the PCA button and administering additional analgesic drugs were significantly lower than those of the control group. CONCLUSION: A 0.3 mg/kg dose of ketamine given at approximately 5 min before surgery resulted in decreasing the number of times pressing the PCA and the administration of additional analgesics.
Pain, Postoperative/drug therapy/*prevention & control ; Middle Aged ; Ketamine/*administration & dosage ; Injections, Intravenous ; *Hysterectomy ; Humans ; Female ; Double-Blind Method ; Anesthesia, General ; Analgesics/*administration & dosage ; Analgesia, Patient-Controlled ; Adult

PURPOSE: This study was performed to evaluate the pre-emptive analgesic effects of a small dose of intravenous ketamine on postoperative pain in patients undergoing a hysterectomy. METHOD: Sixty patients undergoing a hystrectomy under general anesthesia were randomly allocated to 2 groups. The experimental group(30 patients) received 0.3mg/kg of ketamine after induction of anesthesia, approximately 5 min prior to surgery, but the control group(30 patients)did not receive ketamine. Data was collected in a double-blind manner from April 1st, to October 30th, 2004. Postoperatively, the patients used a patient-controlled analgesia(PCA) pump. Blood pressure, pulse rate, pain, anxiety, count of times pressing the PCA button, administeration of additional analgesics and side effects of ketamine were measured at 1 hour, 3 hours, 6 hours and 24 hours after the operation. RESULT: There were no statistical differences in blood pressure, pulse rate, pain and anxiety between the experimental and control groups. There were statistical differences in blood pressure, pulse rate, pain and anxiety during the 24 hours postoperatively. In the experimental group, the number of times pressing the PCA button and administering additional analgesic drugs were significantly lower than those of the control group. CONCLUSION: A 0.3 mg/kg dose of ketamine given at approximately 5 min before surgery resulted in decreasing the number of times pressing the PCA and the administration of additional analgesics.
Pain, Postoperative/drug therapy/*prevention & control ; Middle Aged ; Ketamine/*administration & dosage ; Injections, Intravenous ; *Hysterectomy ; Humans ; Female ; Double-Blind Method ; Anesthesia, General ; Analgesics/*administration & dosage ; Analgesia, Patient-Controlled ; Adult

OBJECTIVETo study the psychedelic effects in healthy volunteers when given subanesthetic dose of ketamine.

METHODSThirteen male healthy volunteers aged 24-39 years were enrolled. All subjects received subanesthetic doses of ketamine using target control infusion. A stepwise series of target plasma concentrations (0, 100, 200, and 300 ng/ml) were maintained for 20 minutes each. Visual analogue scale (VAS) of mechanical pain by von Frey hair was evaluated, and then the volunteers completed a VAS rating of 13 symptom scales. Pictures were shown to them at the same time. Heart rate, mean blood pressure, and SpO2 were monitored throughout the infusion.

RESULTSDuring the process of analgesia, ketamine produced dose-related analgesic effects. With the increase of ketamine dose, some psychedelic effects became more obvious and the memory impairment became worse stepwisely.

CONCLUSIONTarget control infusion of subanesthetic doses of ketamine produce obvious psychedelic effects in healthy volunteers.

Adult ; Anesthetics, Dissociative ; administration & dosage ; adverse effects ; pharmacology ; Dose-Response Relationship, Drug ; Hallucinations ; chemically induced ; Humans ; Ketamine ; administration & dosage ; adverse effects ; pharmacology ; Male