title: Does intraoperative ketamine attenuate inflammatory reactivity following surgery? A systematic review and meta-analysis.
abstract: BACKGROUND
  Reports regarding the ability of the anesthetic drug ketamine to attenuate the inflammatory response to surgery are conflicting. In this systematic review we examined the effect of perioperative ketamine administration on postoperative inflammation as assessed by concentrations of the biomarker interleukin-6 (IL-6).
  
  
  METHODS
  This study was based on a systematic search in PubMed, Scopus, Web of Knowledge, and the Cochrane Library. English written randomized controlled trials conducted in humans were eligible. To be included in the analysis, outcome had to relate to inflammation or immune modulation. Each study was reviewed independently by 2 assessors. Data were analyzed according to the GRADE's approach and reported in compliance with the PRISMA recommendations.
  
  
  RESULTS
  Fourteen studies were eligible for evaluation (684 patients). Surgery was performed under general anesthesia, and ketamine was given before or during the surgery in varied doses Eight studies involved cardiopulmonary bypass operations, 4 were for abdominal surgery, 1 thoracic surgery, and 1 cataract surgery. Three studies were deemed of low quality. Nine studies measured IL-6 concentrations within the first 6 hours postoperatively; but in 3 studies, other potent anti-inflammatory drugs were used as premedication or during the operation; thus 6 studies (n = 331) were included in the meta-analysis. Using postoperative IL-6 concentrations as an outcome, ketamine had an anti-inflammatory effect; the meta-analysis showed a mean preoperative-postoperative IL-6 concentration difference (95% confidence interval) of -71 (-101 to -41) pg/mL.
  
  
  CONCLUSIONS
  It can be concluded that intraoperative administration of ketamine significantly inhibits the early postoperative IL-6 inflammatory response. Future studies should further examine the anti-inflammatory effect of ketamine during major surgery, determine whether ketamine treatment alters functional outcomes, elucidate the mechanisms of its anti-inflammatory effect, and suggest an appropriate dosing regimen.
authors: Discipline of Pharmacology, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia. Ola.Dale@ntnu.no
authors: Ola
authors: O
authors: Dale
authors: Andrew A
authors: AA
authors: Somogyi
authors: Yibai
authors: Y
authors: Li
authors: Thomas
authors: T
authors: Sullivan
authors: Yehuda
authors: Y
authors: Shavit
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D015850:Interleukin-6 / Q000097:blood; D007430:Intraoperative Care / Q000379:methods*; D007649:Ketamine / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
chemical_list: D000893:Anti-Inflammatory Agents; D015850:Interleukin-6; D007649:Ketamine