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Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia

Authors Senapathi T, Widnyana IMG, Wiryana M, Aribawa IGNM, Aryabiantara IW, Hartawan IGAGU, Sinardja IK, Suarjaya IPP, Nada IKW, Jaya AGPS

Received 31 March 2016

Accepted for publication 20 May 2016

Published 20 September 2016 Volume 2016:9 Pages 689—692

DOI https://doi.org/10.2147/JPR.S109616

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Michael E Schatman


Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, Made Wiryana, I Gusti Ngurah Mahaalit Aribawa, I Wayan Aryabiantara, I Gusti Agung Gede Utara Hartawan, I Ketut Sinardja, I Putu Pramana Suarjaya, I Ketut Wibawa Nada, AA Gde Putra Semara Jaya

Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia


Purpose: Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.
Patients and methods: Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively.
Results: Elevation of CRP stress response was lower in the KET group and significantly different (P≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (P>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (P>0.05), but there was a statistically significant (P≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively.
Conclusion: Low-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia.

Keywords: ketamine, stress response, pain, spinal anesthesia, cesarean section

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