Evidence map›Paper›PMID 40906732›Full record

Trial reportPloS one2025

Effects of s-ketamine and midazolam on respiratory variability: A randomized controlled pilot trial.

Oscar F C van den Bosch, Johan P A van Lennep, Ricardo Alvarez-Jimenez, Henriët van Middendorp, Andrea W M Evers, Monique A H Steegers, Patrick Schober, Stephan A Loer

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Oscar F C van den BoschDepartment of Anesthesiology, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands.ORCID https://orcid.org/0000-0002-1653-4029
Johan P A van LennepInstitute of Psychology, Leiden University, Leiden, the Netherlands.
Ricardo Alvarez-JimenezDepartment of Anesthesiology, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands.ORCID https://orcid.org/0000-0001-7581-7566
Henriët van MiddendorpInstitute of Psychology, Leiden University, Leiden, the Netherlands.ORCID https://orcid.org/0000-0003-4575-0895
Andrea W M EversInstitute of Psychology, Leiden University, Leiden, the Netherlands.
Monique A H SteegersDepartment of Anesthesiology, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands.
Patrick SchoberDepartment of Anesthesiology, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands.
Stephan A LoerDepartment of Anesthesiology, Amsterdam UMC location Vrije Universiteit, Amsterdam, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

S-ketamine and midazolam are frequently used to provide sedation while maintaining spontaneous respiration. However, the effects of these agents on respiratory variability, which reflects the adaptability of the respiratory system, have not been thoroughly explored. We evaluated these effects in a randomized controlled pilot trial. This study was conducted as part of a randomized controlled trial originally designed to assess the effects of s-ketamine conditioning on pain sensitivity in patients with fibromyalgia syndrome. Participants were randomly assigned to receive an infusion of either s-ketamine (0.3 mg kg-1 h-1), midazolam (0.05 mg kg-1 h-1), or saline in a blinded fashion. Mean respiratory rate, variability of respiratory rate (VRR), and variability of tidal volume (VTV) were measured continuously and non-invasively with a bio-impedance method. Changes during drug infusion were compared in a linear mixed model to assess the effects of s-ketamine and midazolam compared to saline. Data were analyzed for 57 experiments in 28 participants. Their median baseline variabilities of respiratory rate and tidal volume were 0.19 (IQR: 0.16-0.25) and 0.23 (0.19-0.34), respectively. While mean respiratory rate was not affected, midazolam resulted in a significant decrease in both VRR (ß = -0.071, 95% CI: -0.120 to -0.021) and VTV (ß = -0.117, 95% CI: -0.170 to -0.062). In contrast, s-ketamine appeared to produce a smaller decrease in VTV (ß = -0.062, 95% CI: -0.118 to -0.003) with VRR remaining unaffected (ß = -0.036, 95% CI: -0.092 to 0.019). In conclusion, our study demonstrates that midazolam reduces respiratory variability, potentially impairing the adaptability of the respiratory system. In contrast, s-ketamine largely preserved respiratory variability, suggesting it may be a safer alternative for sedation in patients with impaired spontaneous breathing. Further studies are needed to assess the clinical implications of these observations in patients undergoing sedation.

Indexed as

Hypnotics and SedativesKetamineMidazolamRespirationRespiratory RateAdultFemaleHumansMaleMiddle AgedPilot ProjectsTidal VolumeEsketamineHypnotics and SedativesKetamineMidazolam

Identifiers

PMID40906732
PMCPMC12410786

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.