Kitisin Nuanprae, Raykateeraroj Nattaya, Hemtanon Nattachai, Kamtip Piyawuth, Thikom Napat, Azimaraghi Omid, Piriyapatsom Annop, Chaiwat Onuma, Eikermann Matthias, Wongtangman Karuna
From the Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Nursing, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Anesth Analg. 2025 Sep 1;141(3):598-607. doi: 10.1213/ANE.0000000000007419. Epub 2025 Feb 5.
Low-dose ketamine may have an opioid-sparing effect in critically ill patients but may also predispose them to traumatic memories. We evaluated the effects of low-dose ketamine infusion in the intensive care unit (ICU) on fentanyl consumption and traumatic memories after hospital discharge.
This randomized, double-blind, controlled trial was conducted at a university-based surgical ICU. 118 adult patients who were admitted to the ICU after noncardiac, nonneuro, nontrauma surgery between March 2019 and May 2021 were randomized to receive ketamine 1.5 µg/kg/min (n = 60) or placebo (n = 58). Fentanyl was given to achieve pain control (10-point numerical rating scale pain score [NRS] < 4) and sedation control (Richmond Agitation and Sedation Scale [RASS] level between -2 and 0). A secondary study was conducted by a telephone interview after ICU discharge using the Thai version of the posttraumatic stress disorder (PTSD) questionnaire to evaluate signs and symptoms of PTSD and traumatic memories to the time spent in the ICU.
24-hour fentanyl consumption was lower in patients who received ketamine compared with placebo (399 µg [95% confidence interval {CI}, 345-454] vs 468 µg [95% CI, 412-523], difference -68 µg; 95% CI, -67 to -69; P = .041); RASS and NRS scores did not differ between the 2 groups. Exploratory effect modification analysis suggested that the opioid-sparing effect of ketamine may be more relevant in patients with intraabdominal surgery ( P -for-interaction = 0.012, difference, -177 µg; 95% CI, -204 to -149 µg; P = .001). No acute adverse effects of ketamine were observed. The secondary study included the information from 91 patients from the primary study. Long-term follow-up data was available for 45 patients (23 in the control group, 22 in the ketamine group), and the evaluations were taken 43 ± 8 months after ICU discharge. In this secondary study, ketamine use was associated with a higher incidence of frightening and delusional memories of critical illness and ICU treatment (65% vs 41%, P = .035).
Low-dose ketamine is associated with a small but statistically significant reduction (15%) of postoperative opioid consumption in the ICU. Our secondary study revealed that patients who received low-dose ketamine during fentanyl-based postoperative pain therapy in the ICU recalled more frightening and delusional memories after ICU discharge.
低剂量氯胺酮可能对重症患者具有阿片类药物节省效应，但也可能使他们更容易产生创伤性记忆。我们评估了重症监护病房（ICU）中低剂量氯胺酮输注对出院后芬太尼消耗量和创伤性记忆的影响。
这项随机、双盲、对照试验在一所大学附属的外科ICU进行。2019年3月至2021年5月期间，118例非心脏、非神经、非创伤手术后入住ICU的成年患者被随机分为接受1.5μg/kg/min氯胺酮治疗组（n = 60）或安慰剂组（n = 58）。给予芬太尼以实现疼痛控制（10分数字评分量表疼痛评分[NRS]<4）和镇静控制（里士满躁动和镇静量表[RASS]水平在-2至0之间）。在ICU出院后通过电话访谈进行一项次要研究，使用泰语版创伤后应激障碍（PTSD）问卷来评估PTSD的体征和症状以及在ICU期间的创伤性记忆。
与安慰剂组相比，接受氯胺酮治疗的患者24小时芬太尼消耗量更低（399μg[95%置信区间{CI}，345 - 454] vs 468μg[95%CI，412 - 523]，差值 - 68μg；95%CI， - 67至 -
