Ketamine Versus Propofol Effect on the Immune-mediatory Response for Abdominal Surgery
Brief Summary
Host systemic responses to vigorous stimuli as trauma, surgical tissue injury, anesthesia and post-operative pain, leads to release a variety of pro-inflammatory cytokines including interleukin-1 (IL-1) and interleukin-6 (IL-6) mainly from monocytes and macrophages Thus, the rise of IL-6 is regarded as an early marker of tissue damage and its rise proportional to the degree of tissue damage .
It has been demonstrated that systemic responses to stress may be modified by the anesthetic technique used . Total intravenous anesthesia (TIVA) especially propofol based greatly suppresses the stress response induced by surgery when compared to inhalation by lowering cortisol levels.
Ketamine has the ability to modulate (modify) inflammation . Even the sub-anesthetic doses of ketamine in animal models were even provided to have an effect on the inflammatory response system in the central nervous system
Condition or Disease
- Major Abdominal Surgery
Phase
Study Design
| Study type: | Interventional |
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| Status: | Unknown status |
| Study results: | No Results Available |
| Age: | 18 Years to 70 Years (Adult, Older Adult) |
| Enrollment: | 36 () |
| Funded by: | Other |
Masking |
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Clinical Trial Dates
| Start date: | Jan 10, 2019 | |
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| Primary Completion: | Jun 01, 2019 | |
| Completion Date: | Aug 15, 2019 | |
| Study First Posted: | Jan 04, 2019 | |
| Results First Posted: | Aug 31, 2020 | |
| Last Updated: | Jan 07, 2019 |
Sponsors / Collaborators
The release a variety of pro-inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) mainly from monocytes and macrophages due to surgical trauma or anesthesia .
IL-6 is constantly found in the peripheral blood and rapidly within few minutes unlike other pro inflammatory mediators. Thus, the rise of IL-6 is regarded as an early marker of tissue damage and IL-6 levels are proportional to the degree of tissue damage . The two major actions of IL-6 are having a key role in regulating stress responses by activating the hypothalamic-pituitary- adrenal (HPA) axis and synthesizing fibrinogen (which is necessary for the acute-phase response) serving as a growth factor for activated B-cells .
While appropriate inflammatory reactions are advantageous and essential for wound healing and host defense against microorganisms, excessive immune responses can be detrimental. The released mediators prompt systemic endocrine, immunological and metabolic responses result in increased pain sensitivity, altered metabolism, hyperthermia and greater secretion of liver acute phase proteins and stress hormones, so yields unstable patient's hemodynamic status
Propofol was documented to have an advantage in terms of inflammatory and immunomodulatory effects through significant effect on TNF-α, IL-6 and IL-10 release .
Ketamine has the ability to modulate (modify) inflammation and this is why it is recommended in patients with sepsis undergoing surgery . This may be possibly related with the variations in TNF-α and nuclear factor-κB expression . Even the sub-anesthetic doses of ketamine in animal models were even provided to have an effect on the inflammatory response system in the central nervous system which is involved in its therapeutic effect on depression (Yang-2 et al., 2013).
This study will be conducted to compare between the intravenous infusion of ketamine against the intravenous infusion of propofol during general anesthesia in patients undergoing major abdominal surgeries.
Eligibility Criteria
| Sex: | All |
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| Minimum Age: | 18 |
| Maximum Age: | 70 |
More Details
| NCT Number: | NCT03793075 |
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| Other IDs: | R/18.09.287 |
| Study URL: | https://ClinicalTrials.gov/show/NCT03793075 |