Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/21623
Title: Driving Simulator Performance After Administration of Analgesic Doses of Ketamine With Dexmedetomidine or Fentanyl.
Austin Authors: Hayley, Amie C ;Downey, Luke A;Green, Maja;Shiferaw, Brook;Kenneally, Michaela;Keane, Michael;Adams, Mark;Shehabi, Yahya
Affiliation: Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn
Program of Critical Care and Perioperative Medicine, School of Clinical Sciences, Monash University, Melbourne
Forensic Science South Australia, Adelaide, South Australia, Australia
From the Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn
Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
Department of Oncology, Monash Health Translation Precinct, Monash University, Clayton
From the Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn
Program of Critical Care and Perioperative Medicine, School of Clinical Sciences, Monash University, Melbourne
Issue Date: 19-Aug-2019
metadata.dc.date: 2019-09
Publication information: Journal of clinical psychopharmacology 2019; 39(5): 446-454
Abstract: As a sole agent, ketamine acutely compromises driving ability; however, performance after coadministration with the adjuvant sedating agents dexmedetomidine or fentanyl is unclear. Using a randomized within-subject design, 39 participants (mean ± SD age, 28.4 ± 5.8 years) received 0.3 mg/kg bolus followed by 0.15 mg kg h infusion of ketamine (3-hour duration), in addition to either (i) 0.7 μg kg h infusion of dexmedetomidine for 1.5 hours (n = 19; KET/DEX) or (ii) three 25 μg fentanyl injections for 1.5 hours (n = 20; KET/FENT). Whole blood drug concentrations were determined during ketamine only, at coadministration (KET/DEX or KET/FENT) and at 2 hours after treatment. Subjective effects were determined using a standardized visual analog scale. Driving performance was assessed at baseline and at posttreatment using a validated computerized driving simulator. Primary outcomes included SD of lateral position (SDLP) and steering variability (SV). Administration of ketamine with dexmedetomidine but not fentanyl significantly increased SDLP (F1,18 = 22.60, P < 0.001) and reduced SV (F1,18 = 164.42, P < 0.001) 2 hours after treatment. These deficits were comparatively greater for the KET/DEX group than for the KET/FENT group (t37 = -5.21 [P < 0.001] and t37 = 5.22 [P < 0.001], (respectively). For the KET/DEX group, vehicle control (SV) and self-rated performance (visual analog scale), but not SDLP, was inversely associated with ketamine and norketamine blood concentrations (in nanograms per milliliter). Greater subjective effects were moderately associated with driving deficits. Driving simulator performance is significantly compromised after coadministration of analgesic range doses of ketamine with dexmedetomidine but not fentanyl. An extended period of supervised driver abstinence is recommended after treatment, with completion of additional assessments to evaluate home readiness.
URI: http://ahro.austin.org.au/austinjspui/handle/1/21623
DOI: 10.1097/JCP.0000000000001101
PubMed URL: 31433347
Type: Journal Article
Appears in Collections:Journal articles

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