Ketamine Improves Survival in Burn Injury Followed by Sepsis in Rats

Abstract

Ketamine was reported to decrease cytokine production and improve survival after Escherichia coli-induced sepsis. We examined whether ketamine decreased interleukin (IL)-6 production and improved survival after 1) burn injury or 2) burn injury combined with sepsis (E. coli) at 24 h. Ketamine (10 mg/kg) or saline was given at 1 h after burn injury (G 1, 2, 5, 6), 24 h after burn injury (G 3, 4), or at E. coli inoculation (G 7, 8). Mortality was recorded for 7 days and IL-6 was measured in serum at 6 h after burn (G 1-2), 30 h after burn (G 3-4), or 6 h after sepsis (30 h after burn) (G 5-8). Burn injury only: Ketamine given immediately (1 h) after burn injury but not 24 h after, decreased the burn-induced increase of IL-6 but did not improve survival. Burn injury + sepsis: Ketamine given immediately after burn injury did not significantly decrease the sepsis-induced increase of IL-6 or improve survival. In contrast, ketamine given immediately after sepsis significantly improved survival (46.1% versus 13.3%, P = 0.008) and decreased IL-6 production (72,640 +/- 40,990 vs 332,300 +/- 32,300 pg/mL, P = 0.008). We conclude that ketamine therapy improves survival in burn injury followed by sepsis. This beneficial effect is probably achieved through interference with the inflammatory cascade, as evidenced by attenuation of the proinflammatory marker IL-6.

Effects of Ketamine on Pulmonary Inflammatory Responses and Survival in Rats Exposed to Polymicrobial Sepsis

“…It also has been demonstrated that ketamine could improve survival in burn injury followed by sepsis in rats (33). In the present study, we found that ketamine at the doses of 5 mg/kg and 10 mg/kg could improve survival in a CLP model of sepsis.…”

Effect of low-dose ketamine on inflammatory response in off-pump coronary artery bypass graft surgery

“…Patients were excluded, if they met one of the following criteria: age !75 yr, recent (,14 days) myocardial infarction, unstable angina with elevated creatine kinase-MB (CK-MB), elevated serum creatinine (.1.3 mg dl 21 ) before operation, left ventricular ejection fraction (LVEF) ,40%, previous cardiac surgery, previous stroke or pulmonary disease, and history of treatment with steroid or non-steroidal anti-inflammatory drugs within a month. Emergency operations were also excluded.…”

“…Using a computer-generated randomization method, patients were randomly assigned to receive either a bolus of ketamine 0.5 mg kg 21 (Ketamine group, n¼25) or normal saline (Control group, n¼25) during induction of anaesthesia. Being a double-blinded study, patients, anaesthetic provider, and anaesthetist collecting data were blinded to the study group, and ketamine or normal saline was prepared by an independent researcher in equal volumes in 10 ml syringes.…”

Acute and Perioperative Care of the Burn-Injured Patient

“…Ketamine may exert beneficial anti-inflammatory effects in patients with burns and or sepsis. [70][71][72] Ketamine may be the agent of choice if one wishes to avoid manipulation of the airway (e.g., after placement of fresh facial grafts, for splint or dressing removal, for brief procedures such as dressing or line changes, insertion of Foley catheters in pediatric patients or for patients with toxic epidermal necrolysis syndrome). 73 The addition of benzodiazepines is often recommended to reduce the incidence of dysphoria.…”