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If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".

Electronic Letters to:

Critical Care:
B. Beilin, Y. Rusabrov, Y. Shapira, L. Roytblat, L. Greemberg, I. Z. Yardeni, and H. Bessler
Low-dose ketamine affects immune responses in humans during the early postoperative period
Br. J. Anaesth. 2007; 99: 522-527 [Abstract] [Full text] [PDF]
*E-letters: Submit a response to this article

Electronic letters published:

[Read E-letter] Low-dose ketamine affects immune responses in humans during the early postoperative period
Yasmin Poonawala, Jeff L. Tong   (3 December 2007)

Low-dose ketamine affects immune responses in humans during the early postoperative period 3 December 2007
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Yasmin Poonawala,
Anaesthetic Spr ,
Jeff L. Tong

Send letter to journal:
Re: Low-dose ketamine affects immune responses in humans during the early postoperative period

Editor - We read with interest the article by Beilin et al, (1) which shows that giving low-dose ketamine prior to induction, attenuates IL-6 and TNF-α production and limits immune function alteration, and would like to make some comments.

It has been established that high dose fentanyl and effective post- operative analgesia can attenuate the immune response (reduced suppression of the lymphocyte proliferative response, and attenuation of the proinflammatory cytokine response) caused by anaesthesia and surgery(2). Earlier work by Kim et al, also showed that IL-6 production following surgery was reduced when ketorolac was used to supplement patient- controlled analgesia with morphine(3).

Since the choice of post-operative analgesia can influence the subsequent immune response, we were surprised that a post-operative analgesic protocol for the duration of their study was not described in the methods. We believe that this information is crucial before we fully accept their interesting findings.

Y Poonawala* Birmingham, UK.

JL Tong Royal Centre for Defence Medicine, UK.

*E-mail: yipee_uk@hotmail.com

References

1. Beilin B, Rusabrov Y, Shapira Y, Roytblat L, Greemberg L, Yardeni IZ, Bessler H. Low-dose ketamine affects immune responses in humans during the early postoperative period. Br J Anaesth 2007; 99: 522-7.

2. Beilin B, Shavit Y, Trabekin E, Mordashev B, Mayburd E, Zeidel A, Bessler H. The effects of postoperative pain management on immune response to surgery. Anesth Analg 2003; 97: 822-7.

3. Kim MH, Hahm TS. Plasma levels of interleukin-6 and interleukin- 10 are affected by ketorolac as an adjunct to patient-controlled morphine after abdominal hysterectomy. The Clinical Journal of Pain 2001; 17: 72- 7.

Conflict of Interest:

None declared