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BJA Advance Access originally published online on August 6, 2007
British Journal of Anaesthesia 2007 99(4):522-527; doi:10.1093/bja/aem218
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Low-dose ketamine affects immune responses in humans during the early postoperative period

B. Beilin1,*, Y. Rusabrov2, Y. Shapira2, L. Roytblat2, L. Greemberg2, I. Z. Yardeni1 and H. Bessler3

1 Department of Anaesthesiology and Research Institute, Rabin Medical Center, Hasharon Hospital, 7, Keren Kayemet Street, Petah Tiqva 47372, Israel
2 Division of Anaesthesiology, Soroka Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, Beer-Sheba, Israel
3 The Sackler School of Medicine, Tel-Aviv University, Ramat Aviv, Israel

* Corresponding author. E-mail: beilinb{at}clalit.org.il

Background: Anaesthesia and surgery are associated with impairment of the immune system expressed as an excessive proinflammatory immune response and suppression of cell-mediated immunity that may affect the course of the postoperative period. Addition of anaesthetic agents capable of attenuating the alterations in perioperative immune function may exert a favourable effect on patients’ healing. We have assessed the effect of preoperative administration of a sub-anaesthetic dose of ketamine on the mitogen response and production of interleukin (IL)-1ß, IL-2, IL-6, and tumour necrosis factor (TNF)-{alpha} by peripheral blood mononuclear cells (PBMCs), as well as natural killer cell cytotoxicity (NKCC) in patients undergoing abdominal surgery.

Methods: Seventeen patients admitted for elective abdominal surgery were given ketamine 0.15 mg kg–1 i.v. 5 min before induction of general anaesthesia. Nineteen patients received a similar volume of isotonic saline 5 min before induction of the anaesthesia. PBMCs were isolated from venous blood before and 4, 24, 48, and 72 h after operation for IL-1ß, IL-2, IL-6, and TNF-{alpha} secretion, and NKCC assessment.

Results: Four hours after operation, the cells from patients in the ketamine group showed a significantly suppressed production of IL-6 (P < 0.01) compared with controls. The production of IL-2 did not change from that of the preoperation samples. TNF-{alpha} secretion was significantly elevated in the control group 4 h after operation (P < 0.05).

Conclusions: Addition of small doses of ketamine before induction of anaesthesia resulted in attenuation of secretion of the proinflammatory cytokines IL-6 and TNF-{alpha}, and in preservation of IL-2 production at its preoperative level. It is suggested that this anaesthetic may be of value in preventing immune function alterations in the early postoperative period.

Keywords: anaesthetics, i.v., ketamine; immune response; natural killer cells


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Low-dose ketamine affects immune responses in humans during the early postoperative period
Yasmin Poonawala, et al.
British Journal of Anaesthesia, 3 Dec 2007 [Full text]

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