Clinical case of postoperative anesthesia of a patient by using subanesthetic dose of ketamine in severe abdominal pathology

  • B V Zaletskyi Department of Anesthesiology, IT and Emergency Medicine, National Pirogov Memorial University
  • V A Korobko Department of Anesthesiology and Intensive Care, Vinnytsia regional pediatric clinical hospital
  • D V Dmytriiev Department of Anesthesiology and Intensive Care, Vinnytsia regional pediatric clinical hospital
Keywords: postoperative anesthesia, ketamine, abdominal surgical interventions in children

Abstract

Pain is an inevitable consequence of surgical interventions in children, resulting in great stress and discomfort not only for patients but also for their parents. The intensity of the pain depends not only on the level of injury after the operation, but also on the localization and the nature of the procedure. Management of pain in children is best done through a multimodal approach: opioids, auxiliary drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, anti-neuroleptics such as gabapentin, and regional anesthetic methods. Postoperative anesthesia in abdominal surgery at present is a topical problem in anesthetic practice. In this clinical case, we would like to demonstrate the experience of applying post-operative anesthesia using subnormal dosages of ketamine. The patient was given anesthesia with prolonged infusion of a ketamine solution in a submorbid dose of 0.2 mg/kg/h IV. An assessment of the quality of anesthesia by assessing the level of stress markers, such as blood glucose, cortisol levels, and the assessment of the pain level on the NIPS scale was performed.
Conclusion: The use of a ketamine solution in a dose of 0.2 mg/kg/h has a positive effect on treating postoperative pain in patients after severe abdominal surgical interventions. Applying a ketamine solution in a dose of 0.2 mg/kg/h reduces tolerance of the patient to opioid analgesics and the development of hyperalgesia and allodynia.

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References

Dmytriiev D. (2019). Assessment and treatment of postoperative pain in children. Anaesthesia, Pain & Intensive Care: 392–400.

The Safety and Efficacy of the Continuous Peripheral Nerve Block in Postoperative Analgesia of Pediatric Patients / D. Simić, M. Stević, Z. Stanković et al. // Front. Med; 2018:5(57).

Kulshrestha A. Management of acute postoperative pain in pediatric patients / A. Kulshrestha, S. J. S. Bajwa // Anesth Pain Intens Care:2014; 18(1): 101–5.

Essentials of Regional Anesthesia. Pediatric Pain / L.-A. Oliver, J.-A. Oliver, H. Rayaz, J. L. Lichtor // Springer: 2018; 655–82.

Elia N & Tramèr MR. (2005). Ketamine and postoperative pain – a quantitative systematic review of randomised trials. Pain, 113(1–2): 61–70.

Bell RF, Dahl JB, Moore RA & Kalso EA (2006). Perioperative ketamine for acute postoperative pain. Cochrane database of systematic reviews, (1).

Wulfsohn NL (1972). Ketamine dosage for induction based on lean body mass. Anesthesia & Analgesia, 51(2): 299– 305.

Stubhaug A, Breivik H, Eide PK, Kreunen M & Foss A (1997). Mapping of punctuate hyperalgesia around a surgical incision demonstrates that ketamine is a powerful suppressor of central sensitization to pain following surgery. Acta Anaesthesiologica Scandinavica, 41(9), 1124–32.

Savoia G, Scibelli G & Gammaldi R (1999). Guidelines on acute postoperative pain management. In Regional Anaesthesia Analgesia and Pain Management (pp. 271– 84). Springer, Milano.

Chu LF, Angst MS & Clark D (2008). Opioid-induced hyperalgesia in humans: molecular mechanisms and clinical considerations. The Clinical journal of pain, 24(6), 479–96

Dmytriiev KD & Marchuk OV (2018). Allodynia and hyperalgesia. Pain medicine, 3(2), 24–8.

Colvin LA & Fallon MT (2010). Opioid-induced hyperalgesia: a clinical challenge.

Клінічний випадок післяопераційного знеболення пацієнта шляхом використання субнаркотичних дозувань кетаміну при важкій абдомінальній патології
Published
2019-06-04
How to Cite
1.
Zaletskyi BV, Korobko VA, Dmytriiev DV. Clinical case of postoperative anesthesia of a patient by using subanesthetic dose of ketamine in severe abdominal pathology. PMJUA [Internet]. 2019Jun.4 [cited 2019Jun.25];4(1):61-6. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/191
Section
Clinical thinking