MedWire News: Using ketamine for analgesia during coronary artery bypass graft (CABG) surgery dampens the inflammatory response associated with the procedure, research shows.
The 128 patients in the study underwent elective on-pump CABG surgery. They were randomly assigned to receive either an S-(+)-ketamine 1–3 mg/kg bolus followed by a 2–4 mg/kg infusion, or a sufentanil 0.25–1.00 µg/kg bolus followed by a 0.5–2.0 µg/kg infusion.
All patients received propofol and midazolam, the latter being given to suppress emergence agitation, which is common after the use of ketamine.
Levels of the pro-inflammatory cytokines interleukin (IL)-6 and IL-8 were elevated in both groups at 6 hours after aortic unclamping, but were significantly less so in the ketamine group relative to the sufentanil group. The differences had disappeared by 24 hours, at which point levels had fallen to near baseline values.
Furthermore, levels of the anti-inflammatory cytokine IL-10 were significantly higher in the ketamine than sufentanil group at 1 hour after aortic unclamping.
“However, it is worth mentioning that this difference was not sustained during the postoperative period,” say Christoph Neuhäuser (Universitätsklinikum Gießen und Marburg, Germany) and colleagues.
Levels of other inflammatory markers, including tumor necrosis factor-α and C-reactive protein, did not differ between the two groups.
Hemodynamic variables, such as heart rate, cardiac output, blood pressure, and vascular resistance, were also unaffected by treatment allocation.
“It remains to be investigated whether ketamine displays similar effects in off-pump cardiac surgery,” the team comments in the British Journal of Anaesthesia.
“In addition, further studies powered for outcome are necessary to demonstrate the clinical relevance of ketamine-induced immunomodulation in cardiac surgery.”
