الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Ketamine, an anesthetic first developed in 1970, is one drug that has gained renewed interest as part of the multimodal approach toward acute pain treatment. As an N-methyl-D-aspartate (NMDA) receptor antagonist, ketamine can function as an analgesic by blocking the NMDA receptors involved in nociceptive and inflammatory pain transmission. Knowledge of ketamine’s analgesic properties and mechanism of action has led to the development of clinical trials to assess the drug’s ability to mitigate various pain syndromes, including cancer, neuropathic, refractory chronic, and acute pain. Ketamine’s association with untoward side effects, however, has deterred some from administering the drug in the perioperative setting. In our study we explored the analgesic effect of 1 mg/kg ketamine bolus plus intraoperative 0.12 mg/kg infusion on postoperative pain, hemodynamic for 48hours postoperatively and its effect on CRP and interleukin 6 in patients underwent intestinal surgeries. Using a computer-generated randomization schedule, patients were randomly allocated into two groups of 30 patients each: group K (ketamine): thirty patients received intraoperative intravenous ketamine infusion. group C (control): thirty patients received intraoperative intravenous normal saline infusion. All patients were premedicated with midazolam (1mg, IV) 45 min before surgery plus ondansetron (4 mg). Routine monitoring including electrocardiography (ECG), pulse oximetry (SpO2), and noninvasive blood pressure (NIBP), end tidal co2 and temperature were applied. General anesthesia was induced using fentanyl (1 mcg/kg) and propofol (2.5 mg/kg) and Tracheal intubation was facilitated using 0.5 mg/kg of atracurium. Maintenance of anesthesia was accomplished by isoflurane, in O2. Controlled mechanical ventilation was adjusted to maintain end tidal PCO2 around 35 mmHg. The following data were collected: Patients’ demographic and clinical data including age, sex, weight, height, BMI, ASA, and duration of anesthesia and surgery. Hemodynamic data were recorded intraoperative every 15 min including (mean arterial blood pressure, heart rate, arteria oxygen saturation, end tidal carbon dioxide and cutaneous body temperature). Pain scores in recovery room were recorded at rest and movement at 2,4, 6, 12, 24, 36 and 48 hours after surgery. For VAS scores >40, the nursing staff was instructed to give 0.05 mg/kg of morphine as top-up boluses (rescue analgesic). Hemodynamic data was recorded postoperative at 0, 2, 4, 6, 8,12,24,36, and 48 hours. Serum CRP and IL6 was measured preoperatively and 6 hours postoperatively. Serum CRP was measured using nephelometry done on Advia 1800 fully automated analyzer of Siemens (USA). Serum IL6 was measured using enzyme-linked immune-sorbent assay (ELISA) done by SinoGeneClon Biotech kits. The degree of sedation was assessed using Modified Ramsay Sedation Scale at 2-4-6-8-12, 24, 36 and 48 hours after the surgery.