Blood pressure safety of subanesthetic ketamine for depression: A report on 684 infusions
Blood pressure safety of subanesthetic ketamine for depression: A report on 684 infusions
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DOI：
10.1016/j.jad.2018.02.025
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发表时间：
2018-08-15
影响因子：
6.6
通讯作者：
McDonald, William M.
中科院分区：
文献类型：
--
作者：
Riva-Posse, Patricio;Reiff, Collin M.;McDonald, William M.
背景：解离麻醉剂氯胺酮越来越多地被用于治疗抑郁症，尽管这一适应症没有得到FDA(食品和药物管理局)的批准。关于这种治疗的潜在风险，以及确保患者安全所需的适当设置和监测程度，存在许多问题。关于氯胺酮在亚麻醉剂量下用于治疗抑郁症的心血管安全性的数据有限。方法：在2014年至2016年期间，埃默里大学精神病学系的66名患者总共接受了684次氯胺酮输注。氯胺酮剂量为0.5 mg/kg体重，静注40min以上。结果：患者平均年龄56.7岁，其中87.9%为单相抑郁，36.1%为高血压。没有因生命体征不稳定、不良生理后果或急性精神分裂效应而停止输液。血压在30min时升高最大(收缩压3.28 mm Hg，舒张压3.17 mm Hg)。高血压患者在输液过程中有较高的血压峰值。在输液后监测期间，血压恢复到基线水平。限制：这是一项对自发寻求临床治疗的患者进行的单部位回顾性分析。结论：氯胺酮0.5 mg/kg治疗抑郁症超过40min时，观察到的血压变化很小，耐受性好，临床意义不大。
Background: The dissociative anesthetic agent ketamine is increasingly being utilized to treat depression, despite not having FDA (Food and Drug Administration) approval for this indication. There are many questions about the potential risks of this treatment and hence the proper setting and degree of monitoring required to ensure patient safety. There is limited data about the cardiovascular safety of ketamine when administered at subanesthetic doses to treat depression.Methods: 66 patients in the Department of Psychiatry at Emory University received a total of 684 ketamine infusions between 2014 and 2016. Ketamine was dosed at 0.5 mg/kg body weight and infused over 40 min. Blood pressure was measured every 10 min during the infusions and every 15 min thereafter.Results: Mean age of the patients was 56.7 years, 87.9% had unipolar depression and 36.1% had essential hypertension. No infusions were discontinued due to instability of vital signs, adverse physiological consequences or acute psychotomimetic effects. The biggest increases in blood pressure were measured at 30 min (systolic 3.28 mmHg, diastolic 3.17 mmHg). Hypertensive patients had higher blood pressure peaks during the infusions. Blood pressures returned to baseline during post-infusion monitoring. There was no development of tolerance to the blood pressure elevating effects of ketamine between the first and sixth infusions.Limitations: This is a single site, retrospective analysis, of patients who were spontaneously seeking clinical care.Conclusions: The blood pressure changes observed when ketamine is administered over 40 min at 0.5 mg/kg for the treatment of depression are small, well tolerated and clinically insignificant.