Multidisciplināra ketamīna pielietošana un tā ļaunprātīga izmantošana
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Date
2020
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Journal Title
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Darba aktualitāte: Ketamīnu kā anestēzijas līdzekli radīja 1962. gadā, bet tā blakusefektu dēļ tas ir izpelnījies nevēlamu reputāciju, pieaugot tā izplatībai narkomānu vidū. Tas sekoja par pamatu Ķīnas vēlmei šo medikamentu aizliegt visā pasaulē, kaut arī Āfrikas valstīs tas ir viens no pieejamākiem medikamentiem anestēzijas indukcijai, jo tā efektivitāte nav apšaubīta.
Darba mērķis: Apskatīt un analizēt ketamīna efektivitāti un tā respiratoros blakus efektus anestēzijas indukcijai salīdzinot to ar citiem anestēzijas līdzekļiem.
Materiāls un metodes: Tika veikta literatūras meklēšana izmantojot Pubmed, Cochrane library un EBSCO datubāzes. Analizēšanai tika meklēti pilna teksta publikācijas angļu valodā laika periodā no 2000. gada 1. janvāra līdz 2019. gada 31. decembrim ar randomizēto, dubult-aklo pētīšanas metodiku.
Rezultāti: Analīzei tika iekļauti 3 klīniskie pētījumi ar kopējo pacientu skaitu 748. Izanalizējot šos pētījumus, netika atrastas ketamīna priekšrocības vai trūkumi respiratoro funkciju ziņā, salīdzinot to, lietojot kopā ar propofolu (propofola kombinācija ar ketamīnu tiek apzīmēts kā ketofols) pret propofolu vienu pašu. Taču pētījumiem bija novērojama heterogenitāte sekundārajos iznākumos. Vienam pētījumam bija novērojams, ka ārsti un medmāsas bija vairāk apmierinātas ar sedāciju lietojot ketofolu nekā propofolu (95% confidence interval [CI] 20-40 un CI 11-31, respektīvi, p<0,001). Savukārt, cits pētījums sedāciju novērtēja izmantojot Ramsay Sedation Score un novēroja, ka statistiski labākus rezultātus uzrādīja ketofola grupa (95% CI 8-31, p=0,001)
Secinājumi: Nav statistiski nozīmīgas atšķirības nelabvēlīgo respiratoro notikumu biežumā starp intervenču grupām. Ārsti un medmāsas bija vairāk apmierināti ar ketofola sedāciju. Palielinot propofola devu, lietojot kopā ar ketamīnu, nelabvēlīgo notikumu biežums skaitliski pieauga.
Background: Ketamine as anesthetic was created in 1962, but because of its side effects it got bad reputation and got wide-spread use among drug addicts. It lead to a proposal from China to ban it worldwide, but a lot of African countries were against that since ketamine is one the most affordable and acquirable anesthetic in those countries since ketamine efficacy in this department have not been questioned. Objective: Examine and analyze the efficacy of ketamine and its adverse effects on respiratory system for induction in general anesthesia and compare it with other anesthetic. Material and methods: There was conducted a research using Pubmed, Cochrane Library and EBSCO databases. For the analysis full text researches in english where searched in time frame from 1st of January 2000 to 31st December 2019. Randomized, double-blind trials were the choice of study design in this research Results: Three clinical trials were included for the analysis involving a total of 748 patients. There was found no statistically significant results benefiting or lacking in the patients respiratory functions using ketamine with propofol against propofol alone. However, there was found heterogeneity in the secondary outcomes of these trials. One of these trials showed that physicians and nurses were more satisfactory with the sedation using ketofol than propofol (95% confidence interval [CI] 20-40 un CI 11-31, respektīvi, p<0,001). Another of these researches evalueted sedation using Ramsay Sedation Score which showed that statisically better results was seen with ketofol group (95% CI 8-31, p=0,001). Conclussion: There is no statisticaly significant difference in adverse respiratory effect occurence frequency between intervention groups. Physicians and nurses showed more satisfactory results in sedation using ketofol. Increasing propofol dosage while using with ketamine, respiratory adverse effect frequency grew up.
Background: Ketamine as anesthetic was created in 1962, but because of its side effects it got bad reputation and got wide-spread use among drug addicts. It lead to a proposal from China to ban it worldwide, but a lot of African countries were against that since ketamine is one the most affordable and acquirable anesthetic in those countries since ketamine efficacy in this department have not been questioned. Objective: Examine and analyze the efficacy of ketamine and its adverse effects on respiratory system for induction in general anesthesia and compare it with other anesthetic. Material and methods: There was conducted a research using Pubmed, Cochrane Library and EBSCO databases. For the analysis full text researches in english where searched in time frame from 1st of January 2000 to 31st December 2019. Randomized, double-blind trials were the choice of study design in this research Results: Three clinical trials were included for the analysis involving a total of 748 patients. There was found no statistically significant results benefiting or lacking in the patients respiratory functions using ketamine with propofol against propofol alone. However, there was found heterogeneity in the secondary outcomes of these trials. One of these trials showed that physicians and nurses were more satisfactory with the sedation using ketofol than propofol (95% confidence interval [CI] 20-40 un CI 11-31, respektīvi, p<0,001). Another of these researches evalueted sedation using Ramsay Sedation Score which showed that statisically better results was seen with ketofol group (95% CI 8-31, p=0,001). Conclussion: There is no statisticaly significant difference in adverse respiratory effect occurence frequency between intervention groups. Physicians and nurses showed more satisfactory results in sedation using ketofol. Increasing propofol dosage while using with ketamine, respiratory adverse effect frequency grew up.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
ketamīns, vispārējā anestēzija, propofols, anestēzijas indukcija, intravenozie anestētiķi., ketamine, general anesthesia, propofol, induction of anesthesia, intravenous anesthesia.