Abstract
Ketodex is a combination of ketamine and dexmedetomidine. Ketamine, an old intravenous anesthetic, is a non-narcotic and non-barbiturate drug. It has several properties of the ideal anesthetic agent. However, ketamine can produce the psychological adverse effects. Dexmedetomidine has analgesic, amnesic, sedative and anxiolytic properties. A distinct advantage of dexmedetomidine is the maintenance of respiratory force and preserved airway patency. It converges on a natural sleep pathway, activating pathways that promote endogenous non-rapid eye movement sleep to exert its sedative effect. However, dexmedetomidine can produce bradycardia and hypotension. A combination of ketamine and dexmedetomidine has several benefits in the terms of hemodynamic stability, absence of respiratory depression, post-operative analgesia and recovery. Several previous studies have demonstrated the therapeutic utility of the combination of Order ketamine and dexmedetomidine.
Introduction
Sedoanalgesia drugs are commonly used for sedation and analgesia in several medical procedures. Generally, physicians utilized these agents by the titration technique. Midazolam and fentanyl are the most common sedo analgesic drugs. Midazolam has the shortest half-life and duration of action, making it an ideal agent when prolonged sedation is not compulsory. Midazolam could be reversed with flumazenil. Fentanyl is a potent synthetic opioid with rapid onset, short duration of action, and lack of direct or myocardial depressant effects. Ketamine is a neuroleptic anesthetic agent. It produces analgesia, a dissociative anesthetic state, and unpleasant psychomimetic effects. Dexmedetomidine is a specific central alpha 2-adrenergic agonist that decreases central presynaptic catecholamine release. Its properties of sedation, anxiolysis and analgesia make it a valuable adjunct for procedural and intensive care sedation.
Dexmedetomidine does not appear to be the ideal agent for painful procedures. When used together with ketamine, dexmedetomidine may limit the tachycardia, hypertension, salivation, and emergence phenomena from ketamine, whereas ketamine may prevent the bradycardia and hypotension from dexmedetomidine. A combination of ketamine and dexmedetomidine has low incidence of adverse effects, good analgesic, predictable recovery and no cardiorespiratory depression [1]. To date, there is substantial interest in ketodex as an agent for procedural sedation and analgesia. This present review focuses on the clinical uses of a combination of ketamine and dexmedetomidine.
Ketamine is a dissociative anesthetic agent and is stable at room temperature. It works on thalamocortical and limbic N-methyl-D-aspartate (NMDA) receptors [2]. Ketamine stimulates the cardiorespiratory systems. It causes an increase in cerebral blood flow, intracranial pressure and cerebral metabolic rate. It should be avoided in the patients with ischemic heart disease, hypertension and raised intraocular pressures. However, ketamine produces unpleasant psychological effects including hallucinations, nightmares and emergence reactions. Ketamine could use by several administration routes.
Dexmedetomidine is a specific central alpha 2-adrenergic agonist primarily in the locus coeruleus. Its favorable properties are sedation, anxiolysis and analgesia as well as no respiratory depression. Furthermore, it provides a more wakeful sedation than other sedatives. Patients are more arousable and alert when stimulated. The most common adverse effects associated with its use for procedural sedation are hypotension and bradycardia. However, dexmedetomidine as the sole agent has not been similarly successful for some invasive procedures [3]. Dexmedetomidine is generally used by intravenous injection. However, it could be used by intramuscular injection or by oral premedication. Dexmedetomidine seemed to show complete bioavailability after intramuscular injection. It seemed to be well absorbed systemically through oral mucosa, the buccal bioavailability being as high as 82% [4]. A combination of ketamine and dexmedetomidine is used. Currently, there is a rising number of reports regarding to this combination (ketodex).