Vol 5-1 Research Article

Effectiveness of Intravenous Low-Dose Ketamine Versus Morphine for Procedural Burn Pain Management During Dressing Changes: A Randomized Clinical Trial

Daniel Odhiambo Otieno1*, Stanley O. Khainga2, Joseph Kimani Wanjeri1, Timothy Murithi Mwiti3, Demet S. Sulemanji4

1Department of Plastic, Reconstructive and Aesthetic Surgery, University of Nairobi School of Medicine, Nairobi, Kenya

2Department of Plastic, Reconstructive and Aesthetic Surgery, Moi Teaching and Referral Hospital, Kenya

3Department of the Anesthesia, University of Nairobi School of Medicine, Nairobi, Kenya

4Department of Medicine, The Aga Khan University Hospital, Nairobi, Kenya

Background: There is limited literature on using low-dose intravenous ketamine as a single agent for procedural burn pain management during adult dressing changes.

Aims & Objectives: To determine the effectiveness of low-dose ketamine compared to morphine as a single analgesic agent in procedural burn pain management during dressing changes.

Materials & Methods: We performed an institutional review board-approved, randomized, prospective, double-blinded, controlled, non-inferiority trial. All adult patients 18 years and above scheduled for dressing change were screened. Patients who consented were randomized to receive low-dose ketamine infusion at 0.2mg/kg/hr. In the treatment group, morphine infusion at 0.1mg/kg/hr. In the control group. The primary endpoint was pain intensity, measured using a visual analog scale. Data were analyzed on an intention-to-treat (ITT) approach. Secondary endpoints included rescue analgesia requirements and the occurrence of adverse effects in both groups.

Results: 82 patients were enrolled (ketamine 41 vs. morphine 41). We compared VAS scores at

5-minute intervals during the dressing changes. Overall, pain scores are similar in both groups (p-value=0.595). The pain control was homogenous. However, the morphine group required more rescue analgesia throughout the dressing changes than the low-dose ketamine group (p=0.013 at T15, p<0.001 at T20, and p<0.001 at T30). The occurrence of side effects was similar in both groups.

Conclusion: This study suggests that low-dose ketamine provides as effective and more predictable procedural analgesia as morphine during dressing procedures for adult burn patients.

DOI: 10.29245/2768-5365/2024/1.1149 View / Download Pdf
Vol 5-1 Case Report

Navigating Challenges During Airway Management and Anesthetic Considerations in a Patient with a Supraglottic Mass: Integrating Anesthesiologists and Otolaryngologist Expertise

Najah Arafat Albayedh1*, Muzan Abdelbagi1, Yasser Samir Elmehellawy2, Ragai Abdelbasset Gemi3, Omar Majed Abdul Baki2

1Department of Anesthesia and Critical Care medicine, Al-Qassimi hospital, Emirates Health Services (EHS), Sharjah, United Arab Emirates

2Department of Anesthesia, Al-Qassimi hospital, Emirates Health Services (EHS), Sharjah, United Arab Emirates

3Department of Ear, Nose, and Throat (ENT), Al-Qassimi hospital, Emirates Health Services (EHS), Sharjah, United Arab Emirates. Professor of ENT, Cairo University, Cairo, Egypt

Introduction: Managing patients undergoing head and neck surgeries necessitates meticulous evaluation, strategic planning, and collaborative efforts with surgical teams. This approach is crucial to mitigate perioperative complications and optimize patient safety.

Rationale: Expert navigation of the challenging airway in these patients, particularly in the perioperative period, is essential to significantly reduce the risks of morbidity and mortality associated with such complex conditions.

Patient Concerns and Diagnosis: The patient presented with a supraglottic mass extending into the epiglottis space, posing significant anesthetic challenges to airway management.

Outcomes: A surgical airway was established via tracheostomy. Postoperatively, the patient was monitored in the intensive care unit for further management and was subsequently discharged to commence chemoradiotherapy. The tracheostomy tube remained in place at the time of discharge.

Lessons: This case underscored our commitment to enhancing expertise in airway management for patients with oral cancer. Our experience contributes valuable insights to the evolving field of airway management in complex head and neck surgeries.

DOI: 10.29245/2768-5365/2023/1.1146 View / Download Pdf
Vol 4-3 Editorial

Ethical and Medico-legal Implications of Pain Therapy

Ambika Prasad Patra

Department of Forensic Medicine and Toxicology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India;

DOI: 10.29245/2768-5365/2023/3.1147 View / Download Pdf
Vol 3-1 Commentary

Small stuff, deep underlying emotions: An overview of the positive effect of laughing

Hilde M. Buiting1,2,3,4*, Lisan Ravensbergen4,5, Christa van Schaik6, Vincent K.Y. Ho7

1Antoni van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, the Netherlands

2University Medical Center, Utrecht, the Netherlands

3University of Amsterdam, Amsterdam, the Netherlands

4O2PZ, Platform of Palliative Care, Amsterdam, the Netherlands

5Red Cross Hospital, Department of Anesthesiology, Beverwijk, the Netherlands

6Meander Medisch Centrum, Department of Medical Oncology, Amersfoort, the Netherlands

7Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands

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