BACKGROUNDKetamine is hypothesized to reduce perioperative endocrine-metabolic and inflammatory responses in cardiac surgery patients. This randomized, placebo-controlled, double-blind study was performed to determine whether perioperative endocrine-metabolic and inflammatory responses are attenuated by preoperative administration of ketamine to healthy females receiving elective laparoscopic surgery.

METHODSForty female patients with American Society of Anesthesiologist classification I or II who elected to receive gynecological laparoscopic surgery were randomly assigned to the ketamine-treated (group K; n = 20) or control (group C; n = 20) group. At 2 minutes prior to induction patients in group K received ketamine (0.25 mg/kg) whereas those in group C received normal saline. All patients received standardized general anesthesia. Serum glucose and cortisol values were measured before ketamine administration (T0), 2 minutes after tracheal intubation (T1), 30 minutes after skin incision (T2), 2 minutes after tracheal extubation (T3) and 1 hour postoperatively (T4). Serum interleukin-6 and tumor necrosis factor-α values were determined at T0 and T4. Postoperative analgesic efficacy, side effects of administered drugs, and time to discharge were recorded.

RESULTSCompared with subjects in group C, those in group K had lower serum glucose values at T1, T2, T3 and T4 and lower serum cortisol values at T4 (P < 0.05). Postoperative interleukin-6 and tumor necrosis factor-α concentrations for group K were lower than those for group C (P < 0.05). Postoperative visual analog scale scores at rest, cumulative fentanyl consumption, and time to discharge were lower in group K as compared to group C (P < 0.05). No significant differences in drug side effects were observed postoperatively between the two groups.

CONCLUSIONEndocrine-metabolic and inflammatory responses to laparoscopic surgery are attenuated in part by pre-incisional administration of ketamine.

Analgesics ; therapeutic use ; Double-Blind Method ; Female ; Gynecologic Surgical Procedures ; Humans ; Inflammation ; drug therapy ; prevention & control ; Ketamine ; therapeutic use ; Laparoscopy ; methods

BACKGROUNDCardiopulmonary bypass (CPB) has been shown to be associated with a systemic inflammatory response leading to postoperative organ dysfunction. Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model. The purpose of this study was to establish a good rat model of CPB to study the pathophysiology of potential complications.

METHODSTwenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into a CPB group (n = 10) and a control group (n = 10). All rats were anaesthetized and mechanically ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular and transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 8 ml of colloid. The surface of the hollow fiber oxygenator was 0.075 m(2). CPB was conducted for 60 minutes at a flow rate of 100-120 ml× kg(-1)×min(-1) in the CPB group. Oxygen flow/perfusion flow was 0.8 to 1.0, and the mean arterial pressure remained 60-80 mmHg. Blood gas analysis, hemodynamic investigations, and lung histology were subsequently examined.

RESULTSAll CPB rats recovered from the operative process without incident. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. Mean arterial pressure remained stable. The results of blood gas analysis at different times were within the normal range. Levels of IL-1β and TNF-α were higher in the lung tissue in the CPB group (P < 0.005). Histological examination revealed marked increases in interstitial congestion, edema, and inflammation in the CPB group.

CONCLUSIONThis novel, recovery, and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.

Animals ; Cardiopulmonary Bypass ; methods ; Chlorpromazine ; therapeutic use ; Electrocardiography ; Ketamine ; therapeutic use ; Lung Injury ; drug therapy ; surgery ; Minimally Invasive Surgical Procedures ; methods ; Models, Animal ; Rats ; Rats, Sprague-Dawley

PURPOSE: The aim of this prospective, double-blind, randomized study was to investigate the analgesic effects of low-dose ketamine on intravenous patient-controlled analgesia (IV-PCA) with fentanyl for pain control in pediatric patients following the Nuss procedure for pectus excavatum. MATERIALS AND METHODS: Sixty pediatric patients undergoing the Nuss procedure were randomly assigned to receive fentanyl (Group F, n=30) or fentanyl plus ketamine (Group FK, n=30). Ten minutes before the end of surgery, following the loading dose of each solution, 0.5 microg/kg/hr of fentanyl or 0.5 microg/kg/hr of fentanyl plus 0.15 mg/kg/hr of ketamine was infused via an IV-PCA pump (basal rate, 1 mL/hr; bolus, 0.5 mL; lock out interval, 30 min). Fentanyl consumption, pain score, ketorolac use, nausea/vomiting, ondansetron use, pruritus, respiratory depression, hallucination, dreaming, and parent satisfaction with pain control were measured throughout the 48 hours following surgery. RESULTS: The pain scores, ketorolac use, and fentanyl consumption of Group FK were significantly lower than in Group F (p<0.05). The incidence of nausea/vomiting and ondansetron use in Group FK was significantly lower than in Group F (p<0.05). There were no reports of respiratory depression, hallucination or dreaming. Parent satisfaction with pain control was similar between the two groups. CONCLUSION: We concluded that low-dose ketamine added to IV-PCA with fentanyl after the Nuss procedure in pediatric patients can reduce pain scores, consumption of fentanyl, and incidence of nausea/vomiting without increasing side effects.
Analgesia, Patient-Controlled/*methods ; Analgesics/*therapeutic use ; Child ; Double-Blind Method ; Female ; Fentanyl/*therapeutic use ; Funnel Chest/surgery ; Humans ; Injections, Intravenous ; Ketamine/*therapeutic use ; Male ; Pain, Postoperative/drug therapy

BACKGROUNDHilar cholangiocarcinoma is a malignant tumor that is difficult to cure. The aim of this study was to observe the effects of flow-controlled partial portal vein arterializations (PPVA) on liver regeneration after hepatectomy in minipigs with chronic obstructive jaundice.

METHODSEight minipigs were made into chronic obstructive jaundice models. United semi-hepatectomy, which imitates extended radical surgery for treatment of hilar cholangiocarcinoma, was then performed. The eight minipigs were randomly divided into groups A and B (n = 4 minipigs each). PPVA was performed in Group A but not in Group B. The effects of flow-controlled PPVA on live regeneration after hepatectomy were observed for 30 days after hepatectomy.

RESULTSThe portal vein PO(2) at the immediate time point and on postoperative day 30 was higher in Group A ((47.33 ± 2.43) and (48.50 ± 4.44) mmHg) than in Group B ((35.38 ± 4.06) and (35.55 ± 2.55) mmHg respectively, all P < 0.01). The mitotic index of liver cells on postoperative days 14 and 21 was higher in Group A (12.55% ± 2.85% and 15.25% ± 1.99% respectively) than in Group B (6.85% ± 2.10% and 11.88% ± 1.15% respectively, all P < 0.05). The regeneration rate of residual liver on postoperative days 14 and 21 was higher in Group A (24.56% ± 6.15% and 70.63% ± 9.83% respectively) than in Group B (11.96% ± 5.43% and 44.92% ± 7.42% respectively, P < 0.05 and P < 0.01 respectively).

CONCLUSIONFlow-controlled PPVA can promote liver regeneration after hepatectomy and prevent liver failure in minipigs with chronic obstructive jaundice.

Acepromazine ; therapeutic use ; Animals ; Arteriovenous Shunt, Surgical ; methods ; Atropine ; therapeutic use ; Female ; Hepatectomy ; methods ; Jaundice, Obstructive ; surgery ; Ketamine ; therapeutic use ; Liver Regeneration ; physiology ; Portal Vein ; surgery ; Swine ; Swine, Miniature

OBJECTIVETo observe the effects of anesthetic intervention with small-dose lidocaine and ketamine on early postoperative cognitive function in elderly patients undergoing surgeries for gastrointestinal tumors.

METHODSSixty patients (ASA I-III, aged 63-82 years) scheduled for surgeries for gastrointestinal tumors were randomized into intervention group (n=30) and control group (n=30). After intravenous induction and tracheal intubation, the patients in the interventional group received intravenous infusion of 0.5 mg/kg lidocaine and 0.5 mg/kg ketamine, followed by continuous infusion of lidocaine at the rate of 0.5 mg·kg(-1)·h(-1) till the end of the operation; the patients in the control group received saline infusion only. The cognitive function of the patients was assessed at 3 day before and 2 day after the operation using comprehensive neuro-psychological tests. Peripheral venous blood was extracted before anesthesia induction (T0), at the end of the surgery (T1), and at 1 day (T2) and 2 days (T3) after the operation for measurement of serum S-100β protein, NSE and IL-6 levels using ELISA.

RESULTSThe difference between the test scores before and after the operation (X values) was significantly smaller in the intervention group than in the control group (P<0.05). The intervention group showed a significantly lower incidence rate of postoperative cognitive dysfunction (POCD) than the control group (6.7% vs 33.3%, P<0.05). Compared with the control group, the intervention group exhibited significantly lower serum levels of S-100β protein, NSE and IL-6 at T1 (P<0.05), significantly lower NSE and IL-6 levels at T2 (P<0.05) time point, and significantly lower IL-6 level at T3 (P<0.05).

CONCLUSIONIntravenous injection of small-dose lidocaine and ketamine during the operation can reduce the incidence of POCD in elderly patients undergoing surgeries for gastrointestinal tumors possibly in relation to decreased serum S-100β, NSE and IL-6 levels.

Aged ; Aged, 80 and over ; Anesthetics ; therapeutic use ; Cognition ; drug effects ; Gastrointestinal Neoplasms ; surgery ; Humans ; Interleukin-6 ; blood ; Ketamine ; therapeutic use ; Lidocaine ; therapeutic use ; Postoperative Complications ; Postoperative Period ; S100 Calcium Binding Protein beta Subunit ; blood

Animals ; Animals, Newborn ; Brain ; drug effects ; metabolism ; pathology ; Disease Models, Animal ; Excitatory Amino Acid Antagonists ; pharmacology ; therapeutic use ; Female ; Hypoxia-Ischemia, Brain ; drug therapy ; metabolism ; Ketamine ; pharmacology ; therapeutic use ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Treatment Outcome

OBJECTIVE: To observe the effect of intrathecal injection of ketamine and clonidine for chronic constriction injury (CCI) in rats. METHODS: Thirty-two SD male rats weighing 220-280 g were anesthetized with intraperitoneal chloral hydrate 300 mg/kg. A catheter was implanted in the subarachnoid space at the lumbal region and CCI rat models were made successfully. On the 4th day after the surgery, the rats were randomly divided into 4 group: a control group,injecting 0.9%NS 20 microL intrathecally; a ketamine group, injecting ketamine 1 mg/kg(20 microL) intrathecally; a clonidine group (CL), injecting clonidine 20 microg/kg (20 microL) intrathecally; a combined ketamine and clonidine group, injecting ketamine 0.5mg/kg and clonidine 10 g/kg (20 microL) intrathecally, once a day for 1 week. BME-410A Plantar Analgesia Tester was used to measured pain threshold before the administration and 30 min after the administration. The rats were killed after the test was finished. And then we detected the nitric oxide synthase (NOS) activity and the NO production in the spinal cord. RESULTS: The combined injection of ketamine (0.5mg/kg)and clonidine(10 g/kg) produced significantly more potent analgesia than the injection of ketamine (1 mg/ kg) or clonidine (20 microg/ kg)alone. The NOS activity and the production of NO in the combined injection group were significantly lower than those of the single injection group (P<0.05). The weight of rats post-administration increased obviously in the 4 groups (P<0.05). CONCLUSION The combined injection of ketamine and clonidine can produce synergistic ab-irritation without obvious side effects.
Analgesics ; administration & dosage ; adverse effects ; therapeutic use ; Animals ; Clonidine ; administration & dosage ; adverse effects ; therapeutic use ; Drug Combinations ; Injections, Spinal ; Ketamine ; administration & dosage ; adverse effects ; therapeutic use ; Male ; Neuralgia ; drug therapy ; Nitric Oxide ; metabolism ; Nitric Oxide Synthase ; metabolism ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; drug effects ; metabolism

This study was performed to compare the effect of intratesticular (IT) injection of xylazine/ketamine combination for canine castration with those of intramuscular (IM) or intravenous (IV) injection. Xylazine and ketamine was administered simultaneously via intratesticularly (IT group), intramuscularly (IM group) or intravenously (IV group) at doses of 2 and 10 mg/kg, respectively. Pain response at the time of injection, mean induction time, mean arousal time, mean walking time and cardiopulmonary function during anesthesia were monitored after the xylazine and ketamine administration. In IV and IM groups, heart rates were significantly decreased 30 and 45 min after xylazine and ketamine administration, respectively (p < 0.05). Respiratory rates were significantly decreased in the IV group (p < 0.05). In the IT group, there was no significant changes in heart and respiratory rates. The occurrence of cardiac arrhythmias was less severe in IT group compared with those in IM and IV groups. The route of administration did not affect rectal temperature. Mean induction time was significantly (p < 0.05) longer in IT group than in IM and IV groups. On the contrary, mean arousal time and mean walking time were shortened in IT group. Clinical signs related to pain response at the time of injection and vomiting were less observed in IT group than in IM group, and head shaking was less shown in IT group than in IM and IV groups during recovery period. These results indicated that intratesticular injection of xylazine/ketamine for castration has several advantages such as less inhibition of cardiopulmonary function and fast recovery from anesthesia without severe complications, and would be an effective anesthetic method for castration in small animal practice.
Anesthesia, Intravenous/veterinary ; Anesthetics, Combined/adverse effects/*therapeutic use ; Anesthetics, Dissociative/adverse effects/*therapeutic use ; Animals ; Body Temperature/drug effects ; Castration/*veterinary ; Dogs ; Drug Administration Routes/veterinary ; Electrocardiography/drug effects/veterinary ; Heart Rate/drug effects ; Injections/veterinary ; Injections, Intramuscular/veterinary ; Ketamine/adverse effects/*therapeutic use ; Male ; Pain, Postoperative/prevention&control/veterinary ; Pulmonary Ventilation/drug effects ; Testis/*drug effects ; Vomiting/chemically induced/veterinary ; Xylazine/adverse effects/*therapeutic use

The effects of vitamin C on ketamine anesthesia was studied. In normal rabbits the onset and duration of ketamine induced anesthesia were 6.0+/-0.5 and 36.0+/-0.9 min, respectively. Pre-treatment of rabbits with 30, 60 and 240 mg/kg, i.m. of vitamin C followed by ketamine 40 mg/ kg i.m. resulted in significant (p<0.05)decrease in the onset and increase in duration of ketamine anesthesia to 5.0 +/-0.06 and 37.0+/-0.7;4.0 +/-0.5 and 39.0*0.6;2.0+/-2.3 and 44.0+/-0.8 min, respectively. There was also significant (p<0.05)decrease in the heart rates in the animals treated with vitamin C and ketamine combinations. Serum analysis showed a significant (p<0.05)increase in blood glucose. The observed decreased in serum calcium and phosphorous following ketamine injection was prevented by pretreatment with vitamin C. These results suggest that vitamin C at higher doses could potentiate ketamine anesthesia in rabbits.
Anesthesia/*veterinary ; Anesthesia, General/*veterinary ; *Anesthetics, Dissociative ; Animals ; Ascorbic Acid/*therapeutic use ; Bicarbonates/blood ; Blood Glucose/drug effects ; Body Temperature/drug effects ; Calcium/blood ; Dose-Response Relationship, Drug ; Female ; Heart Rate/drug effects ; *Ketamine ; Male ; Oxygen/blood ; Premedication/*veterinary ; *Rabbits ; Respiration/drug effects

OBJECTIVETo investigate the protective effect of low-dose ketamine against intestinal ischemia reperfusion injury following pneumoperitoneum with carbon dioxide in rats.

METHODSThirty healthy male adult SD rats (body weight 280-320 g) were randomized into sham-operated group, model group and ketamine group and subjected to pneumoperitoneum for 120 min with carbon dioxide (not in sham-operated group). The rats in ketamine group received an intraperitoneal injection of 10 mg/kg ketamine 10 min before pneumoperitoneum, and those in the other two groups received saline injection. Fifteen minutes after pneumoperitoneum or sham operation, the small intestines were sampled to detect the content of malondialdehyde (MDA) and fore pathological testing. ELISA was used to detect the serum levels of I-FABP, TNF-α IL-6 and IL-8.

RESULTSPneumoperitoneum caused a significant increase in intestinal MDA content (P<0.05), which was lowered by ketamine pretreatment (P<0.05). Serum I-FABP, TNF-α, IL-6 and IL-8 levels all significantly increased following pneumoperitoneum (P<0.05) and were obviously lowered by ketamine pretreatment (P<0.05). Pneumoperitoneum also caused obvious pathologies in intestinal mucosa, which were ameliorated by ketamine pretreatment.

CONCLUSIONLow-dose ketamine preconditioning can reduce the inflammatory reaction and lessen oxidative damage in the intestinal mucosa following pneumoperitoneum in rats.

Animals ; Carbon Dioxide ; Dose-Response Relationship, Drug ; Fatty Acid-Binding Proteins ; blood ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Intestine, Small ; blood supply ; metabolism ; pathology ; Ketamine ; administration & dosage ; therapeutic use ; Male ; Malondialdehyde ; metabolism ; Pneumoperitoneum ; chemically induced ; complications ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; blood ; etiology ; metabolism ; pathology ; prevention & control ; Tumor Necrosis Factor-alpha ; blood