title: [Sympathetic activity of S-(+)-ketamine low doses in the epidural space].
abstract: OBJECTIVE
  S-(+)-ketamine is an intravenous anaesthetic and sympathomimetic with properties of local anaesthetic. It has an effect of an analgetic and local anaesthetic when administered epidurally, but there are no data whether low doses of S-(+)-ketamine have sympathomimetic effects. The aim of this study was to determine whether low doses of S-(+)-ketamine, given epidurally together with local anaesthetic, have any effect on sympathetic nervous system, both systemic and below the level of anaesthetic block.
  
  
  METHODS
  The study was conducted on two groups of patients to whom epidural anaesthesia was administered to. Local anaesthesia (0.5% bupivacaine) was given to one group (control group) while local anaesthesia and S-(+)-ketamine were given to other group. Age, height, weight, systolic, diastolic and mean arterial blood pressure were measured. Non-competitive enzyme immunochemistry method (Cat Combi ELISA) was used to determine the concentrations of catecholamines (adrenaline and noradrenaline). Immunoenzymometric determination with luminescent substrate on a machine called Vitros Eci was used to determine the concentration of cortisol. Pulse transit time was measured using photoplethysmography. Mann-Whitney U-test, Wilcoxon test and Friedman ANOVA were the statistical tests. Blood pressure, pulse, adrenaline, noradrenaline and cortisol concentrations were measured in order to estimate systemic sympathetic effects.
  
  
  RESULTS
  40 patients in the control group were given 0.5% bupivacaine and 40 patients in the test group were given 0.5% bupivacaine with S-(+)-ketamine. Value p<0.05 has been taken as a limit of statistical significance.
  
  
  CONCLUSIONS
  Low dose of S-(+)-ketamine administered epidurally had no sympathomimetic effects; it did not change blood pressure, pulse, serum hormones or pulse transit time. Low dose of S-(+)-ketamine administered epidurally did not deepen sympathetic block. Adding 25mg of S-(+)-ketamine to 0.5% bupivacaine does not deprive sympathetic tonus below the level of epidural block at the moment of most expressed sympathetic block and has no effect on sympathetic tonus above the block level.
authors.affiliation: Hospital de Clínicas de Zagreb, Faculdade de Medicina da Universidade de Zagreb, Klinički Bolnički Centar, Zagreb, Croácia. Electronic address: smsmihaljevic@gmail.com.
authors.forename: Slobodan
authors.initials: S
authors.lastname: Mihaljevic
authors.affiliation: Hospital de Clínicas de Zagreb, Faculdade de Medicina da Universidade de Zagreb, Klinički Bolnički Centar, Zagreb, Croácia.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Mihaljevic
authors.affiliation: Hospital de Clínicas de Zagreb, Faculdade de Medicina da Universidade de Zagreb, Klinički Bolnički Centar, Zagreb, Croácia.
authors.forename: Marko
authors.initials: M
authors.lastname: Cacic
keywords: Atividade simpática; Cetamina S‐(+); Doses baixas; Epidural space; Espaço epidural; Low doses; Sympathetic activity; S‐(+)‐ketamine