title: S(+)-ketamine increases muscle sympathetic activity and maintains the neural response to hypotensive challenges in humans.
abstract: BACKGROUND
  S(+)-Ketamine is reported to exert twofold greater analgesic and hypnotic effects but a shorter recovery time in comparison with racemic ketamine, indicating possible differential effects of stereoisomers. However, cardiovascular regulation during S(+)-ketamine anesthesia has not been studied. Muscle sympathetic activity (MSA) may be an indicator of the underlying alterations of sympathetic outflow. Whether S(+)-ketamine decreases MSA in a similar manner as the racemate is not known. Thus, the authors tested the hypothesis that S(+)-ketamine changes MSA and the muscle sympathetic response to a hypotensive challenge.
  
  
  METHODS
  Muscle sympathetic activity was recorded by microneurography in the peroneal nerve of six healthy participants before and during anesthesia with S(+)-ketamine (670 microg/kg intravenously followed by 15 microg x kg(-1) x min(-1)). Catecholamine and ketamine plasma concentrations, heart rate, and arterial blood pressure were also determined. MSA responses to a hypotensive challenge were assessed by injection of sodium nitroprusside (2-10 microg/kg) before and during S(+)-ketamine anesthesia. In the final step, increased arterial pressure observed during anesthesia with S(+)-ketamine was adjusted to preanesthetic values by sodium nitroprusside infusion (1-6 microg x kg(-1) x min(-1)).
  
  
  RESULTS
  Anesthesia with S(+)-ketamine (ketamine plasma concentration 713 +/- 295 microg/l) significantly increased MSA burst frequency (mean +/- SD; 18 +/- 6 to 35 +/- 11 bursts/min) and burst incidence (32 +/- 10 to 48 +/- 15 bursts/100 heartbeats) and was associated with a doubling of norepinephrine plasma concentration (from 159 +/- 52 to 373 +/- 136 pg/ml) parallel to the increase in MSA. Heart rate and arterial blood pressure also significantly increased. When increased arterial pressure during S(+)-ketamine was decreased to awake values with sodium nitroprusside, MSA increased further (to 53 +/- 24 bursts/min and 60 +/- 20 bursts/100 heartbeats, respectively). The MSA increase in response to the hypotensive challenge was fully maintained during anesthesia with S(+)-ketamine.
  
  
  CONCLUSIONS
  S(+)-Ketamine increases efferent sympathetic outflow to muscle. Despite increased MSA and arterial pressure during S(+)-ketamine anesthesia, the increase in MSA in response to arterial hypotension is maintained.
authors.affiliation: Abteilung für Anästhesiologie und Intensivmedizin, Universität Essen, Germany. peter.kienbaum@uni-essen.de
authors.forename: P
authors.initials: P
authors.lastname: Kienbaum
authors.forename: T
authors.initials: T
authors.lastname: Heuter
authors.forename: G
authors.initials: G
authors.lastname: Pavlakovic
authors.forename: M C
authors.initials: MC
authors.lastname: Michel
authors.forename: J
authors.initials: J
authors.lastname: Peters
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D006339:Heart Rate / Q000187:drug effects; D007022:Hypotension / Q000503:physiopathology*; D007649:Ketamine / Q000494:pharmacology*; D009132:Muscles / Q000294:innervation*; D009599:Nitroprusside / Q000494:pharmacology; D009638:Norepinephrine / Q000097:blood; D012119:Respiration / Q000187:drug effects; D013237:Stereoisomerism; D013564:Sympathetic Nervous System / Q000187:drug effects* / Q000502:physiology
chemical_list: D009599:Nitroprusside; D007649:Ketamine; D009638:Norepinephrine