[Role of ketamine in sepsis and systemic inflammatory response syndrome].
Ketamine is the only intravenous anesthetic that causes an increase in mean arterial pressure without compromising cardiac output. These beneficial effects are basically linked to stimulation of the sympathetic nervous system, inhibition of adenosine triphosphate-sensitive potassium channels and interactions with the nitric oxide pathway. Experimental and clinical studies have shown that ketamine exerts antiinflammatory properties by inhibiting the release of proinflammatory cytokines, such as tumor necrosis factor-alpha and interleukin-6. In addition, there is increasing evidence that early ketamine administration reduces mortality in experimental sepsis models. In view of the current literature ketamine appears to represent a beneficial therapeutic option for long-term sedation of patients with arterial hypotension resulting from sepsis and systemic inflammatory response syndrome (SIRS). However, it has to be taken into account that ketamine inhibits endothelial nitric oxide synthase, thereby potentially aggravating impaired (micro) regional blood flow in sepsis. Future studies are required to investigate the role of ketamine in the treatment of patients with sepsis and SIRS.
Lange
M
M
Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum, Albert-Schweitzer-Str. 33, 48149 Münster. lange-m@anit.uni-muenster.de
Bröking
K
K
van Aken
H
H
Hucklenbruch
C
C
Bone
H-G
HG
Westphal
M
M
D000255:Adenosine Triphosphate / Q000378:metabolism; D000778:Anesthetics, Dissociative / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001794:Blood Pressure / Q000187:drug effects; D016207:Cytokines / Q000378:metabolism; D004791:Enzyme Inhibitors / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D007649:Ketamine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology; D052250:Nitric Oxide Synthase Type III / Q000037:antagonists & inhibitors; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D018805:Sepsis / Q000188:drug therapy* / Q000503:physiopathology; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy* / Q000503:physiopathology
D000778:Anesthetics, Dissociative; D000894:Anti-Inflammatory Agents, Non-Steroidal; D016207:Cytokines; D004791:Enzyme Inhibitors; D007649:Ketamine; D000255:Adenosine Triphosphate; D052250:Nitric Oxide Synthase Type III