Stable anesthesia with alternative to opioids

Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials

Patrice Forget (Corresponding Author), Juan Cata

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction
The role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery.

Methods
The available literature published on PubMed/Medline and EMBASE was reviewed systematically to perform meta-analyses of randomized controlled trials (RCTs) assessing the effect of ketamine and/or magnesium on hemodynamic response to surgery as the primary outcome.

Results
From 352 studies, we identified 19 RCTs, and after exclusion of eight studies (seven for inappropriate data reporting and one in non-English language), we analyzed 11 RCTs (five for ketamine and six for magnesium sulfate) including, in total, 371 patients, of whom 94 vs. 95 received ketamine vs. placebo and 147 vs. 145 received magnesium vs. placebo, respectively. Results show that in quantitative analyses, ketamine vs. placebo did not show a significant effect on heart rate (+0.71 bpm; 95% CI [−1.52 to +2.93], P = 0.53) but significantly reduced variability of blood pressure (−8.4 mmHg; 95% CI [−15.1 to −1.8], P = 0.0005). In contrast, magnesium vs. placebo reduced variability of heart rate (−3.7 bpm; 95% CI [−6.5 to 0.9], P = 0.01) without a significant effect on systemic blood pressure (+4.2 mmHg; 95% CI [−3.6 to +12.03], P = 0.29).

Conclusion
In conclusion, these meta-analyses of nine trials confirm that ketamine and magnesium, differently but consistently, reduce hemodynamic variability during surgery and may be seen as complementary not only for pain control but also to provide stable anesthesia. This study supports the use of those drugs to control the sympathetic response to surgery in the context of opioid-free anesthesia.
Original languageEnglish
Pages (from-to)523-531
Number of pages9
JournalBest Practice & Research Clinical Anaesthesiology
Volume31
Issue number4
Early online date8 Jul 2017
DOIs
Publication statusPublished - Dec 2017

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Ketamine
Magnesium
Opioid Analgesics
Meta-Analysis
Anesthesia
Randomized Controlled Trials
Hemodynamics
Placebos
Heart Rate
Blood Pressure
Magnesium Sulfate
Drug and Narcotic Control
Postoperative Pain
PubMed
Research Design
Language
Pain

Keywords

  • ketamine
  • magnesium
  • hemodynamics
  • postoperative pain

Cite this

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title = "Stable anesthesia with alternative to opioids: Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials",
abstract = "IntroductionThe role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery.MethodsThe available literature published on PubMed/Medline and EMBASE was reviewed systematically to perform meta-analyses of randomized controlled trials (RCTs) assessing the effect of ketamine and/or magnesium on hemodynamic response to surgery as the primary outcome.ResultsFrom 352 studies, we identified 19 RCTs, and after exclusion of eight studies (seven for inappropriate data reporting and one in non-English language), we analyzed 11 RCTs (five for ketamine and six for magnesium sulfate) including, in total, 371 patients, of whom 94 vs. 95 received ketamine vs. placebo and 147 vs. 145 received magnesium vs. placebo, respectively. Results show that in quantitative analyses, ketamine vs. placebo did not show a significant effect on heart rate (+0.71 bpm; 95{\%} CI [−1.52 to +2.93], P = 0.53) but significantly reduced variability of blood pressure (−8.4 mmHg; 95{\%} CI [−15.1 to −1.8], P = 0.0005). In contrast, magnesium vs. placebo reduced variability of heart rate (−3.7 bpm; 95{\%} CI [−6.5 to 0.9], P = 0.01) without a significant effect on systemic blood pressure (+4.2 mmHg; 95{\%} CI [−3.6 to +12.03], P = 0.29).ConclusionIn conclusion, these meta-analyses of nine trials confirm that ketamine and magnesium, differently but consistently, reduce hemodynamic variability during surgery and may be seen as complementary not only for pain control but also to provide stable anesthesia. This study supports the use of those drugs to control the sympathetic response to surgery in the context of opioid-free anesthesia.",
keywords = "ketamine, magnesium, hemodynamics, postoperative pain",
author = "Patrice Forget and Juan Cata",
year = "2017",
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doi = "10.1016/j.bpa.2017.07.001",
language = "English",
volume = "31",
pages = "523--531",
journal = "Best Practice & Research Clinical Anaesthesiology",
issn = "1521-6896",
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}

TY - JOUR

T1 - Stable anesthesia with alternative to opioids

T2 - Are ketamine and magnesium helpful in stabilizing hemodynamics during surgery? A systematic review and meta-analyses of randomized controlled trials

AU - Forget, Patrice

AU - Cata, Juan

PY - 2017/12

Y1 - 2017/12

N2 - IntroductionThe role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery.MethodsThe available literature published on PubMed/Medline and EMBASE was reviewed systematically to perform meta-analyses of randomized controlled trials (RCTs) assessing the effect of ketamine and/or magnesium on hemodynamic response to surgery as the primary outcome.ResultsFrom 352 studies, we identified 19 RCTs, and after exclusion of eight studies (seven for inappropriate data reporting and one in non-English language), we analyzed 11 RCTs (five for ketamine and six for magnesium sulfate) including, in total, 371 patients, of whom 94 vs. 95 received ketamine vs. placebo and 147 vs. 145 received magnesium vs. placebo, respectively. Results show that in quantitative analyses, ketamine vs. placebo did not show a significant effect on heart rate (+0.71 bpm; 95% CI [−1.52 to +2.93], P = 0.53) but significantly reduced variability of blood pressure (−8.4 mmHg; 95% CI [−15.1 to −1.8], P = 0.0005). In contrast, magnesium vs. placebo reduced variability of heart rate (−3.7 bpm; 95% CI [−6.5 to 0.9], P = 0.01) without a significant effect on systemic blood pressure (+4.2 mmHg; 95% CI [−3.6 to +12.03], P = 0.29).ConclusionIn conclusion, these meta-analyses of nine trials confirm that ketamine and magnesium, differently but consistently, reduce hemodynamic variability during surgery and may be seen as complementary not only for pain control but also to provide stable anesthesia. This study supports the use of those drugs to control the sympathetic response to surgery in the context of opioid-free anesthesia.

AB - IntroductionThe role of ketamine and magnesium in improving postoperative pain and diminish opioid consumption has been largely described. Synthetic opioids are known to provide hemodynamic stability when given for major noncardiac surgery. Definitive evidence on the role of ketamine and/or magnesium on intraoperative hemodynamic control would support their potential as alternatives to opioids during surgery.MethodsThe available literature published on PubMed/Medline and EMBASE was reviewed systematically to perform meta-analyses of randomized controlled trials (RCTs) assessing the effect of ketamine and/or magnesium on hemodynamic response to surgery as the primary outcome.ResultsFrom 352 studies, we identified 19 RCTs, and after exclusion of eight studies (seven for inappropriate data reporting and one in non-English language), we analyzed 11 RCTs (five for ketamine and six for magnesium sulfate) including, in total, 371 patients, of whom 94 vs. 95 received ketamine vs. placebo and 147 vs. 145 received magnesium vs. placebo, respectively. Results show that in quantitative analyses, ketamine vs. placebo did not show a significant effect on heart rate (+0.71 bpm; 95% CI [−1.52 to +2.93], P = 0.53) but significantly reduced variability of blood pressure (−8.4 mmHg; 95% CI [−15.1 to −1.8], P = 0.0005). In contrast, magnesium vs. placebo reduced variability of heart rate (−3.7 bpm; 95% CI [−6.5 to 0.9], P = 0.01) without a significant effect on systemic blood pressure (+4.2 mmHg; 95% CI [−3.6 to +12.03], P = 0.29).ConclusionIn conclusion, these meta-analyses of nine trials confirm that ketamine and magnesium, differently but consistently, reduce hemodynamic variability during surgery and may be seen as complementary not only for pain control but also to provide stable anesthesia. This study supports the use of those drugs to control the sympathetic response to surgery in the context of opioid-free anesthesia.

KW - ketamine

KW - magnesium

KW - hemodynamics

KW - postoperative pain

U2 - 10.1016/j.bpa.2017.07.001

DO - 10.1016/j.bpa.2017.07.001

M3 - Article

VL - 31

SP - 523

EP - 531

JO - Best Practice & Research Clinical Anaesthesiology

JF - Best Practice & Research Clinical Anaesthesiology

SN - 1521-6896

IS - 4

ER -