The Effect Of Low-dose Ketamine On Tumor Necrosis Factor-a And Interleukin-6 In The Patients Undergoing Laparoscopic Cholecystectomy

Objectives:: 1. Whether the administration of lowdose Ketaminleads to a depressant effect on blood TNF-a, IL-6 level of laparoscopiccholecystectomy patients;2. Whether this depressant effect caused by Ketamine isdose-dependent;3. The analgesic effect of lowdose Ketamine after the effect ofRemifentani vanished.Methods: 1. 30 in hospital patients were collected who are going totake laparoscopic cholecystectomy (LC) and without severe trauma orinfection. There were 14 male and 16 female with age 30～69, weight46.5～85 kg and the ASA gradeⅠ～Ⅱ. All 30 patients were randomlydivided into three groups: group k1 and k2 for drug treatment and groupD for control, with each group contained 10 patients. Anesthesiainduction was performed with Remifentani 1μg/kg, Midazolam 0.1mg/kgand Vecuronium bromide 0.1mg/kg. Ketamine 0.8mg/kg was injected forgroup k1 and Vecuronium bromide 0.2mg/kg for group k2. Same volumeNS was injected for group D. Remifentani TCI 6ng/kg and PropofolTCI1-1.5ug/ml were given via venous pump for patients of all 3 groups.Tracheal intubation was performed 5 minutes after induction andVecuronium bromide was given intermittently during the operation. Systolic blood pressure, mean arterial blood pressure, diastolic bloodpresure, heart rate and saturation of blood oxygen of all patients weremeasured and recorded at several different time as follow: Beforeanaesth(T0), 1 minute after tracheal intubation(T4), 3 minutes aftertracheal intubation(T5), 5 minutes after tracheal intubation(T6).2. Specimen collection: The anesthetist visited patients the nightbefore operation, illustrated the method of visual analogue and gotcompliance, established two venous channels after the patient arrived atthe operation room, with one for drug injection and the other for bloodspecimen collection. The specimen were collected for the measurement ofTNF-a, IL-6 at three different time respectively: before anaesth(T0), 1hour after operation(T2), 24 hours after operation(T3). The visualanalogue scale of wound pain were also performed at three different timerespectively: 30 minutes after operation(T1), 1 hour after operation(T2)and 24 hours after operation(T3)Results: 1. The blood level of TNF-a, IL-6 and Visual analoguescale are all significantly different among the 3 groups. All of the 3 indexin group kl and group k2 are higher than group D. and all of the 2 indexvaried at differents time; TNF-a, IL-6 interact with time.2. Heart rate, systolic blood pressure, mean arterial blood pressure,diastolic blood presure are significantly different among the three groups(P＜0.05) while the saturation of blood oxygen is not s Conclusions: 1. Lowdose Ketamine generates a depressant effect onblood TNF-a, IL-6 level of the LC patients. What is more, this effect canbe enhanced by the drug dosage.2. Lowdose Ketamine brings about a preemptive analgesia effect toLC patients, which means it causes a postoperation analgesia after theeffectiveness of Remifentani vanished.3. Ketamine 0.5mg/kg (group K2) in the anesthesia induction canminimizes the change of heart rate during the tracheal intubation. Thesystolic blood pressure, mean arterial blood pressure, diastolic bloodpresure are significantly lower than the other two groups (P＜0.05), whichmeans it can notably relieves the stress reaction of the tracheal intubation.