Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.
Division of Hematology, Boston Children's Hospital, Boston, Massachusetts, USA.
Pediatr Blood Cancer. 2023 May;70(5):e30254. doi: 10.1002/pbc.30254. Epub 2023 Mar 2.
Typical sickle cell disease (SCD) vaso-occlusive pain episode (VOE) management includes opioids, which are often inadequate and can be associated with significant side effects. Ketamine, a dissociative anesthetic, is a potentially effective adjunct to VOE management.
This study aimed to characterize ketamine use for VOE management in pediatric SCD.
This retrospective case series summarizes a single-center experience regarding the use of ketamine for inpatient management of pediatric VOE in 156 admissions from 2014 to 2020.
Continuous low-dose ketamine infusion was most commonly prescribed to adolescents and young adults as an adjunct to opioids (median starting dose 2.0 μg/kg/min; median maximum dose 3.0 μg/kg/min). Ketamine was started a median of 13.7 hours after admission. Median ketamine infusion duration was 3 days. In most encounters, ketamine infusion was discontinued prior to opioid patient-controlled analgesia (PCA) discontinuation. The majority of encounters (79.3%) had a reduction in either PCA dose, continuous opioid infusion, or both while receiving ketamine. Low-dose ketamine infusion was associated with side effects noted in 21.8% (n = 34) of encounters. The most common side effects included dizziness (5.6%), hallucinations (5.1%), dissociation (2.6%), and sedation (1.9%). There were no reports of ketamine withdrawal. Most patients who received ketamine went on to receive it again during a subsequent admission.
Further study is needed to determine the optimal timing of ketamine initiation and dosing. The variability of ketamine administration highlights the need for standardized protocols for ketamine use in VOE management.
典型的镰状细胞病（SCD）血管阻塞性疼痛发作（VOE）的管理包括阿片类药物，但这些药物往往不够有效，并且可能会产生显著的副作用。氯胺酮，一种分离麻醉剂，是 VOE 管理的一种潜在有效辅助手段。
本研究旨在描述氯胺酮在儿科 SCD 患者 VOE 管理中的应用。
本回顾性病例系列总结了 2014 年至 2020 年期间，在一家中心，156 例住院患者使用氯胺酮辅助治疗儿科 VOE 的经验。
持续低剂量氯胺酮输注最常被开给青少年和年轻人，作为阿片类药物的辅助手段（中位起始剂量 2.0μg/kg/min；中位最大剂量 3.0μg/kg/min）。氯胺酮的起始时间中位数为入院后 13.7 小时。氯胺酮输注的中位持续时间为 3 天。在大多数情况下，在停止使用阿片类药物患者自控镇痛（PCA）之前，停止了氯胺酮输注。在大多数情况下（79.3%），在接受氯胺酮治疗的同时，PCA 剂量、持续输注阿片类药物或两者均减少。在 34 次（21.8%）就诊中发现低剂量氯胺酮输注与副作用有关。最常见的副作用包括头晕（5.6%）、幻觉（5.1%）、分离（2.6%）和镇静（1.9%）。没有氯胺酮戒断的报告。大多数接受氯胺酮治疗的患者在随后的住院期间再次接受了氯胺酮治疗。
需要进一步研究以确定氯胺酮起始和剂量的最佳时机。氯胺酮给药的变异性突出了在 VOE 管理中使用氯胺酮需要标准化方案。
