title: Intravenous ketamine during spinal and general anaesthesia for caesarean section: systematic review and meta-analysis.
abstract: BACKGROUND
  Intravenous ketamine has been used during general and regional anaesthesia for caesarean section. No systematic review and meta-analysis on the desired effects and adverse effects of ketamine administration during caesarean section have yet been performed.
  
  
  METHODS
  After a systematic literature search a meta-analysis was conducted with the random effects model. Weighted mean difference (WMD) or risk ratio and 95% confidence intervals (CIs) were computed.
  
  
  RESULTS
  Twelve randomised controlled double-blind trials comprising 953 patients were included: seven studies reported on spinal anaesthesia and five on general anaesthesia. Significant differences in the aforementioned outcome variables were found only in the spinal anaesthesia studies. In the spinal anaesthesia studies the time to the first analgesic request was significantly longer in ketamine-treated women, the WMD was 49.36 min (95% CI 43.31-55.41); visual analogue scale pain scores at rest 2 h after surgery were significantly lower. No differences were observed for maternal nausea, vomiting, pruritus, and psychomimetic effects. Only few data were found for neonatal outcomes.
  
  
  CONCLUSIONS
  We conclude that ketamine enhances post-operative analgesia after caesarean section under spinal anaesthesia. There is a paucity of data for several maternal adverse effects as well as for neonatal well-being. Further studies are needed for general anaesthesia.
authors: Department of Anesthesia, Klinikum am Bruderwald, Bamberg, Germany; Department of Anesthesia, Kantonsspital Baden, Baden, Switzerland.
authors: M
authors: M
authors: Heesen
authors: J
authors: J
authors: Böhmer
authors: E C V
authors: EC
authors: Brinck
authors: V K
authors: VK
authors: Kontinen
authors: S
authors: S
authors: Klöhr
authors: R
authors: R
authors: Rossaint
authors: S
authors: S
authors: Straube
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000778:Anesthetics, Dissociative / Q000008:administration & dosage*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D011247:Pregnancy
chemical_list: D000778:Anesthetics, Dissociative; D007649:Ketamine