S [+] Ketamine suppresses TNF-alpha, IL-6 and IL-8 production in blood in major abominal surgery under combined epidural general anestesia

ABSTRACT

Cytokines are essential for hematopoiesis and immune responses, and they play a key role in the defense against infection. It has been demonstrated that proinflammatory cytokines such as [TNF-alpha], interleukin [IL] 6 and IL-8 increase in patients with trauma, surgical trauma, sepsis burns. 40 patients scheduled for major abdominal surgery under combined epidural general anaesthesia in Kasr, EI-Aini Hospital were included in this study. Patients age was ranged between 18-50 years, patients were ASA I and II. The patients were divided into 2 groups each group 20 patients, group I was received S [+] Ketamine as a single preincision dose, while in II S [+] Ketamine was received preincision and as a repeated doses, S [+] ketamine was injected as a single IV dose 0.5 mg/kg before incision in both groups, and repeated 0.2 mg/kg doses at 20 minutes interval until 30 minutes before the end of the operation [In group II, 20 patients only]. This study reported that S [+] ketamine suppressed TNF-alpha production IL-6, IL-8. The study also reported that a single S [+] ketamine preincision dose decreased IL-6 to 550 +/- 20 at 30 minutes before end of operation while the repeated 20 minutes doses decreased IL-6 to 440 +/- 20 minutes. IL-8 when single dose of S [+] ketamine was given decreased to 850 +/- 50 at 30 minutes before end of the operation, while after repeated S [+] ketamine it was 600'40 at 30 minutes before operation, about TNF-a. It decreased to reach 1110 +/- 180 in a single dose ofS [+] ketamine while it decreased to 1000 +/- 120 in repeated dose of S [+] ketamine. The total dose of S [+] ketamine was 35+30 in single dose group, while it was 80 +/- 40 in repeated dose group, the dose ofropivacaine given epidurally was 148 +/- 20 in single group while it was 130 +/- 15 in repeated group. This mean the anesthetics required in repeated doses of S [+] group was lower, indicated that S [+] ketamine decreased the anesthetics requirement. The conclusion of the study was S [+] ketamine directly suppresses proinflammatory cytokines production when given in repeated doses, it also decreased the ropivacaine dose needed more in repeated doses of S [+] ketamine. A larger study is also needed to assess whether the favorable postoperative effect of S [+] ketamine make differ