Ali Hassan Mohamed, Mokhtar Ali M
Department of Anesthesia, Cairo University, Cairo, Egypt.
Anesth Essays Res. 2017 Apr-Jun;11(2):282-286. doi: 10.4103/aer.AER_28_17.
Radical prostatectomy is a major surgical procedure that is associated with marked inflammatory response and impairment of the immune system which may affect the postoperative outcome. The aim of this study was to evaluate the effect of preincision single or multiple doses of S(+) ketamine on the pro-inflammatory cytokines, namely tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6).
This is a randomized controlled trial including 60 American Society of Anesthesiologists Physical Status I and II patients scheduled for radical prostatectomy under combined general-epidural anesthesia in Cairo university Teaching Hospital. Patients were randomly divided into three groups each of twenty patients: Group I received no S(+) ketamine (control group), Group II received S(+) ketamine as a single preincision dose, and Group III received preincision and repeated doses of S(+) ketamine. S(+) ketamine was injected as a single intravenous dose of 0.5 mg/kg in Group II and III, repeated as 0.2 mg/kg at 20 min interval until 30 min before the end of surgery.
The three groups were comparable in age, weight, and duration of the operation. The study also revealed that a single preincision dose of S(+) ketamine decreased TNF-α to reach 1027.04 ± 50.13 μ/ml and IL-6 to reach 506.89 ± 25.35 pg/ml whereas the repeated doses of S(+) ketamine decreased TNF-α to reach 905.64 ± 35065 μ/ml and IL-6 to reach 412.79 ± 16.5 pg/ml ( < 0.05).
S(+) ketamine suppresses pro-inflammatory cytokine production, especially when given in repeated doses.
根治性前列腺切除术是一种大型外科手术，会引发显著的炎症反应和免疫系统损伤，这可能会影响术后结果。本研究的目的是评估术前单次或多次给予S(+)氯胺酮对促炎细胞因子，即肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）的影响。
这是一项随机对照试验，纳入了60例美国麻醉医师协会身体状况分级为I级和II级的患者，他们计划在开罗大学教学医院接受全身-硬膜外联合麻醉下的根治性前列腺切除术。患者被随机分为三组，每组20例：第一组未接受S(+)氯胺酮（对照组），第二组接受术前单次剂量的S(+)氯胺酮，第三组接受术前及重复剂量的S(+)氯胺酮。第二组和第三组中，S(+)氯胺酮以0.5 mg/kg的单次静脉注射剂量给药，在手术结束前30分钟每隔20分钟以0.2 mg/kg的剂量重复给药。
三组在年龄、体重和手术持续时间方面具有可比性。研究还表明，术前单次剂量的S(+)氯胺酮可使TNF-α降至1027.04±50.13 μ/ml，IL-6降至506.89±25.35 pg/ml，而重复剂量的S(+)氯胺酮可使TNF-α降至905.64±35.065 μ/ml，IL-6降至412.79±16.5 pg/ml（P<0.05）。
S(+)氯胺酮可抑制促炎细胞因子的产生，尤其是重复给药时。
