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评估氯胺酮作为小儿急性哮喘加重期支气管扩张剂的安全性和有效性:一项综述。

Evaluating the Safety and Efficacy of Ketamine as a Bronchodilator in Pediatric Patients With Acute Asthma Exacerbation: A Review.

作者信息

Binsaeedu Abdullah S, Prabakar Deipthan, Ashkar Mohammed, Joseph Cassie, Alsabri Mohammed

机构信息

College of Medicine, Alfaisal University College of Medicine, Riyadh, SAU.

Medical Intern, Government Kilpauk Medical College, Chennai, IND.

出版信息

Cureus. 2023 Jun 22;15(6):e40789. doi: 10.7759/cureus.40789. eCollection 2023 Jun.

DOI:10.7759/cureus.40789
PMID:37485092
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10362785/
Abstract

Ketamine has emerged as a potential treatment option for pediatric patients with acute asthma exacerbation who do not respond to standard therapy. This review aims to evaluate the safety and efficacy of ketamine in this population and provide an overview of the current literature. A comprehensive search was conducted in PubMed and Google Scholar, resulting in the identification of four relevant studies. The studies demonstrated that ketamine administration led to improvements in respiratory parameters, including a decrease in clinical asthma scores (CASs) and respiratory rates, and an increase in peak expiratory flow and oxygen saturation. Ketamine infusion also showed promise in obviating the need for intubation in patients with severe wheezing due to bronchiolitis. The most common side effects observed were increased tracheobronchial secretions and hallucinations, which were manageable through discontinuation or additional medication. No significant changes in heart rate and blood pressure were reported, indicating hemodynamic stability. Long-term complications of ketamine use were minimal, with no reports of nightmares or dysphoria. In conclusion, ketamine shows potential as a bronchodilator for pediatric patients with acute asthma exacerbation, although further research is needed to fully evaluate its effectiveness and long-term effects. The use of ketamine should be considered in carefully selected cases and closely monitored for adverse events.

摘要

氯胺酮已成为对标准治疗无反应的急性哮喘加重期儿科患者的一种潜在治疗选择。本综述旨在评估氯胺酮在该人群中的安全性和有效性,并概述当前的文献。在PubMed和谷歌学术上进行了全面检索,共识别出四项相关研究。这些研究表明,给予氯胺酮可改善呼吸参数,包括临床哮喘评分(CASs)降低、呼吸频率降低、呼气峰值流量和血氧饱和度增加。氯胺酮输注在避免因细支气管炎导致严重喘息的患者进行插管方面也显示出前景。观察到的最常见副作用是气管支气管分泌物增加和幻觉,可通过停药或额外用药进行处理。未报告心率和血压有显著变化,表明血流动力学稳定。氯胺酮使用的长期并发症极少,没有关于噩梦或烦躁不安的报告。总之,氯胺酮对急性哮喘加重期儿科患者显示出作为支气管扩张剂的潜力,尽管需要进一步研究以充分评估其有效性和长期影响。在精心挑选的病例中应考虑使用氯胺酮,并密切监测不良事件。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebfc/10362785/ed009b2caeee/cureus-0015-00000040789-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebfc/10362785/ed009b2caeee/cureus-0015-00000040789-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ebfc/10362785/ed009b2caeee/cureus-0015-00000040789-i01.jpg

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Vital Signs: Asthma in Children - United States, 2001-2016.生命体征:美国2001 - 2016年儿童哮喘情况
MMWR Morb Mortal Wkly Rep. 2018 Feb 9;67(5):149-155. doi: 10.15585/mmwr.mm6705e1.
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Behavioral Changes in Children After Emergency Department Procedural Sedation.儿童在急诊科程序镇静后行为的变化。
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Cureus. 2024 Jun 16;16(6):e62483. doi: 10.7759/cureus.62483. eCollection 2024 Jun.
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Study on the antidepressant activity of (2R,6R; 2S,6S)-Hydroxynorketamine (HNK) and its derivatives.(2R,6R; 2S,6S)-羟基去甲氯胺酮(HNK)及其衍生物的抗抑郁活性研究。
Clinics (Sao Paulo). 2024 Jul 11;79:100435. doi: 10.1016/j.clinsp.2024.100435. eCollection 2024.
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[Lung-protective effect of esketamine combined with distal limb ischemic preconditioning in elderly patients undergoing thoracoscopic radical surgery for lung cancer: a randomized controlled trial in 160 cases].艾司氯胺酮联合远端肢体缺血预处理对老年肺癌患者胸腔镜根治手术的肺保护作用:一项160例随机对照试验
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