Article ; Online: Stereoselective ketamine effect on cardiac output: a population pharmacokinetic/pharmacodynamic modelling study in healthy volunteers.
British journal of anaesthesia
2021 Volume 127, Issue 1, Page(s) 23–31
Abstract: Background: Ketamine has cardiac excitatory side-effects. Currently, data on the effects of ketamine and metabolite concentrations on cardiac output are scarce. We therefore developed a pharmacodynamic model derived from data from a randomised clinical ... ...
| Abstract | Background: Ketamine has cardiac excitatory side-effects. Currently, data on the effects of ketamine and metabolite concentrations on cardiac output are scarce. We therefore developed a pharmacodynamic model derived from data from a randomised clinical trial. The current study is part of a larger clinical study evaluating the potential mitigating effect of sodium nitroprusside on the psychedelic effects of ketamine. Methods: Twenty healthy male subjects received escalating esketamine and racemic ketamine doses in combination with either placebo or sodium nitroprusside on four visits: (i) esketamine and placebo, (ii) esketamine and sodium nitroprusside, (iii) racemic ketamine and placebo, and (iv) racemic ketamine and sodium nitroprusside. During each visit, arterial blood samples were obtained and cardiac output was measured. Nonlinear mixed-effect modelling was used to analyse the cardiac output time-series data. Ketamine metabolites were added to the model in a sequential manner to evaluate the effects of metabolites. Results: A model including an S-ketamine and S-norketamine effect best described the data. Ketamine increased cardiac output, whereas modelling revealed that S-norketamine decreased cardiac output. No significant effects were detected for R-ketamine, metabolites other than S-norketamine, or sodium nitroprusside on cardiac output. Conclusions: S-Ketamine, but not R-ketamine, increased cardiac output in a dose-dependent manner. In contrast to S-ketamine, its metabolite S-norketamine reduced cardiac excitation in a dose-dependent manner. Clinical trial registration: Dutch Cochrane Center 5359. |
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| MeSH term(s) | Adult ; Anesthetics, Dissociative/chemistry ; Anesthetics, Dissociative/pharmacokinetics ; Cardiac Output/drug effects ; Cardiac Output/physiology ; Cross-Over Studies ; Dose-Response Relationship, Drug ; Double-Blind Method ; Healthy Volunteers ; Humans ; Ketamine/chemistry ; Ketamine/pharmacokinetics ; Male ; Stereoisomerism ; Young Adult |
| Chemical Substances | Anesthetics, Dissociative ; Ketamine (690G0D6V8H) |
| Language | English |
| Publishing date | 2021-04-22 |
| Publishing country | England |
| Document type | Journal Article ; Randomized Controlled Trial |
| ZDB-ID | 80074-0 |
| ISSN | 1471-6771 ; 0007-0912 |
| ISSN (online) | 1471-6771 |
| ISSN | 0007-0912 |
| DOI | 10.1016/j.bja.2021.02.034 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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