Sedation with ketamine during intradiscal electrothermal therapy

Spine
Steven P Cohen, Thomas Larkin

Abstract

A technical report. To present a new and improved method to sedate patients during intradiscal electrothermal therapy (IDET). The current standard of practice is to sedate patients with short-acting benzodiazepines and opioids during the coagulation phase of intradiscal electrothermal therapy. There are few data on the subject, but it is estimated that between 5% and 20% of IDET procedures are either aborted early or switched to a lower heating temperature because patients cannot tolerate the optimal, recommended heating protocol. A priori, one must assume these patients are more likely to fail their treatment than those who are able to tolerate complete heating. The authors treated 9 patients receiving intradiscal electrothermal therapy who were unable to tolerate the latter portion of their heating protocol secondary to axial low back pain despite high doses of opioids, with low dose ketamine. This paper outlines our experience with "rescue" doses of ketamine, along with the rationale and guidelines for its use. After receiving ketamine, all patients were able to complete the full intradiscal electrothermal therapy heating protocol. The rescue dosages of ketamine ranged from 15 to 55 mg. The dosages of midazolam used to preve...Continue Reading

References

Jun 1, 1984·Acta Anaesthesiologica Scandinavica·G Lenz, R Stehle
Sep 1, 1996·Anesthesia and Analgesia·S HimmelseherM Georgieff
Dec 7, 2002·Journal of Spinal Disorders & Techniques·Steven P CohenDavid W Polly
Apr 1, 2000·Neuromodulation : Journal of the International Neuromodulation Society·R DerbyD Ryan

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Citations

Jul 25, 2007·Anesthesia and Analgesia·Steven P CohenEugene J Carragee

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