title: Effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.
abstract: OBJECTIVE
  Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia.
  
  
  METHODS
  Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18). Ketamine 0.3 mg/kg (KET group) or NaCl 0.9% (NS group) was administered intravenously before the administration of spinal anesthesia. C-reactive protein (CRP) and neutrophil levels were measured preoperatively and postoperatively.
  
  
  RESULTS
  Elevation of CRP stress response was lower in the KET group and significantly different (P≤0.05) from that in the NS group. Neutrophil level was elevated in both the groups and hence not significantly different from each other (P>0.05). Postoperative visual analog scale pain score was not significantly different between the two groups (P>0.05), but there was a statistically significant (P≤0.05) positive and weak correlation between visual analog scale and CRP level postoperatively.
  
  
  CONCLUSIONS
  Low-dose intravenous ketamine effectively attenuates the CRP stress response in patients undergoing emergency cesarean section with spinal anesthesia.
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: Tjokorda Gde Agung
authors.initials: TG
authors.lastname: Senapathi
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: I Made Gede
authors.initials: IM
authors.lastname: Widnyana
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: Made
authors.initials: M
authors.lastname: Wiryana
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: I Gusti Ngurah Mahaalit
authors.initials: IG
authors.lastname: Aribawa
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: I Wayan
authors.initials: IW
authors.lastname: Aryabiantara
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: I Gusti Agung Gede Utara
authors.initials: IG
authors.lastname: Hartawan
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: I Ketut
authors.initials: IK
authors.lastname: Sinardja
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: I Putu Pramana
authors.initials: IP
authors.lastname: Suarjaya
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: I Ketut Wibawa
authors.initials: IK
authors.lastname: Nada
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Sanglah Hospital, Bali, Indonesia.
authors.forename: Aa Gde Putra Semara
authors.initials: AG
authors.lastname: Jaya
keywords: cesarean section; ketamine; pain; spinal anesthesia; stress response