The effect of Kitamine on production of inflammatory markers in post operative patients in Mulago Hospital: A randomized clinical trial.

Abstract

BACKGROUND: Mulago hospital provides anaesthesia services for many patients undergoing surgical procedures. Anaesthesia and surgery are associated with immune system response, manifested as an increased pro-inflammatory immune mediator release or increased pain modulation, which may affect or prolong postoperative recovery. Ketamine, a cheap and readily available anaesthetic induction agent, has been reported to have attenuation effects in atopic individuals and asthmatics, and improves paediatric patient outcomes after cardiac surgery.

RESEARCH QUESTION: Can 0.5mg/kg of Ketamine given preoperatively have an effect on the post operative levels of pro-inflammatory markers?

STUDY OBJECTIVE: To study the effect of, low dose, 0.5mg/kg of Ketamine administered preoperatively on the postoperative pro-inflammatory marker IL-6 and IL-1beta levels, in adult patients undergoing elective surgery in Mulago hospital.

STUDY METHOD: A stage 2 phase 4, prospective, randomized, double-blind, placebocontrolled trial was conducted in the main operating theatres of Mulago hospital among patients undergoing elective surgery. 39 patients were recruited and randomized to receive either IV ketamine 0.5 mg/kg or an equal volume of normal saline before induction of anesthesia. Blood samples were taken at baseline before administering intervention, in PACU, 24 and 48 hours post operatively. These determined the IL-1β and IL-6 levels. The study was registered under the clinical trials domain www.clinicaltrials.gov ClinicalTrials.gov Identifier: NCT01339065

RESULTS: Indicated 0.5 mg/kg ketamine given at induction added to Opioid-based anesthesia, suppresses the increase of serum IL-6 at PACU and at 24 hours after surgery. IL-beta was not found in 98% of analyzed samples of the surgical population studied as there was no reaction in the pre-coated ELIZA antibodies micro wells on assay.

CONCLUSION: Serum IL-6 levels correlate with patient’s clinical course during and after surgery it is therefore recommended, that in non contraindicated patients, low dose ketamine is beneficial.