Neurocognitive effects of repeated ketamine infusion treatments in patients with treatment resistant depression: A retrospective chart review

BackgroundKetamine has emerged as a rapid-acting antidepressant in treatment-resistant depression (TRD) increasingly used in non-research, clinical settings. Few studies, however, have examined neurocognitive effects of repeated racemic ketamine infusion treatments in patients with TRD. In an effort to identify potential effects after serial infusions, we conducted a retrospective chart review to identify statistically significant changes in cognition in patient undergoing serial intravenous infusions; concomitantly, we examined baseline cognition as potential predictor of anti-depressant potential. MethodsTwenty-two patients with TRD were examined after they finished the induction phase of 8-10 repeated intravenous ketamine infusions and completed the assessments of their depressive symptoms (measured by the 16-item Quick Inventory of Depressive Symptomatology-Self Report Scale: QIDS-SR16) and cognitive function (measured by the Montreal Cognitive Assessment: MoCA) before the first and the last ketamine treatments. ResultsRepeated ketamine infusions administered through an escalating dose protocol with 8-10 infusion sessions produced a 47.2% reduction response in depression; there was no evidence of impairment as reflected in MoCA testing. There was a moderate association between baseline cognition and antidepressant response with a pearson correlation of 0.453. ConclusionIn this naturalistic sample of patients with TRD in our clinical service, repeated ketamine infusions significantly decreased depression symptoms without impairing cognitive performance. The baseline cognition may positively predict antidepressant responses of repeated ketamine treatment.

Ketamine for Acute Pain After Trauma: KAPT Trial

BackgroundEvidence for effective pain management and opioid minimization of intravenous ketamine in elective surgery has been extrapolated to acutely injured patients, despite limited supporting evidence in this population. This trial seeks to determine the effectiveness of the addition of sub-dissociative ketamine to a pill-based, opioid-minimizing multi-modal pain regimen (MMPR) for post traumatic pain.MethodsThis is a single-center, parallel-group, randomized, controlled comparative effectiveness trial comparing a MMPR to a MMPR plus a sub-dissociative ketamine infusion. All trauma patients 16 years and older admitted following a trauma which require intermediate (IMU) or intensive care unit (ICU) level of care are eligible. Prisoners, patients who are pregnant, patients not expected to survive, and those with contraindications to ketamine are excluded from this study. The primary outcome is opioid use, measured by morphine milligram equivalents (MME) per patient per day (MME/patient/day). The secondary outcomes include total MME, pain scores, morbidity, lengths of stay, opioid prescriptions at discharge, and patient centered outcomes at discharge and six months.DiscussionThis trial will determine the effectiveness of sub-dissociative ketamine infusion as part of a MMPR in reducing in-hospital opioid exposure in adult trauma patients. Furthermore, it will inform decisions regarding acute pain strategies on patient centered outcomes.Trial Registration:The Ketamine for Acute Pain Management After Trauma (KAPT) with registration # NCT04129086 was registered on 10/16/2019 and is available at https://clinicaltrials.gov/ct2/show/NCT04129086?term=ketamine+injury&draw=2&rank=6

The Effect of Low Dose Ketamine Infusion versus Low Dose Dexmedetomidine Infusion on Stress Responses in Coronary Artery Bypass Graft Surgery

Background In cardiac surgery, the extent of systemic inflammatory response is closely Mobile associated with patient’s outcome. A systemic inflammatory response syndrome (SIRS) may develop after operations using cardiopulmonary bypass (CPB). Aim of the Work to evaluate the 01006705713 potential effects of intravenous infusion of ketamine versus dexmedetomidine on attenuation f stress responses during coronary artery bypass grafting (CABG) operation. Patients and Email [email protected] Methods This randomized controlled interventional study was conducted on 90 patients who dinaunderwent elective CABG procedure at Ain Shams University Hospital over 24 months from Jan 2018 to Jan 2020. The patients were divided into 3 groups, 30 patients for each group. Group D: received dexmedetomidine infusion, Group K: received ketamine infusion and Group N (control group): received normal saline. Then following measurements recorded at following time interval before induction of anesthesia (T1), after weaning from CPB (T2), 24 h(T3) and 48 h(T4) after completion of the anastomoses. Mean arterial blood pressure records, heart rate & Inflammatory and stress markers including CRP, cortisol, WBC count, glucose and lactate levels. Results Mean arterial pressure among three groups was not statistically significant. Also serum glucose level was not statistically significant between groups. Serum lactate level didn’t show statistically significant difference between groups. From aspects of inflammatory markers, we got good results which were superior for dexmedetomidine followed by ketamine infusion group suggested by statistically significant, suggesting that dexmedetomidine and ketamine may have a role in attenuation inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery. Conclusion Our study that compared Intravenous infusion of ketamine and dexmedetomidine on attenuation of stress responses during coronary artery bypass grafting (CABG) operation suggests that dexmedetomidine was superior to ketamine infusion in attenuation of inflammatory response during cardiac surgery but have no role in attenuation stress response to surgery.

Baseline Working Memory Predicted Response to Low-Dose Ketamine Infusion in Patients with Treatment-Resistant Depression

Introduction Pretreatment neurocognitive function may predict the treatment response to low-dose ketamine infusion in patients with treatment-resistant depression (TRD). However, the association between working memory function at baseline and the antidepressant efficacy of ketamine infusion remains unclear. Methods A total of 71 patients with TRD were randomized to one of three treatment groups: 0.5 mg/kg ketamine, 0.2 mg/kg ketamine, or normal saline. Depressive symptoms were measured using the 17-item Hamilton Depression Rating Scale (HDRS) at baseline and after treatment. Cognitive function was evaluated using working memory and go-no-go tasks at baseline. Results A generalized linear model with adjustments for demographic characteristics, treatment groups, and total HDRS scores at baseline revealed only a significant effect of working memory function (correct responses and omissions) on the changes in depressive symptoms measured by HDRS at baseline (F=12.862, p<0.05). Correlation analysis further showed a negative relationship (r=0.519, p=0.027) between pretreatment working memory function and changes in HDRS scores in the 0.5 mg/kg ketamine group. Discussion An inverse relationship between pretreatment working memory function and treatment response to ketamine infusion may confirm that low-dose ketamine infusion is beneficial and should be reserved for patients with TRD.