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CRITICAL CARE AND TRAUMA

Ketamine Improves Survival in Burn Injury Followed by Sepsis in Rats

Reuven Gurfinkel, MD^*, David Czeiger, MD, Amos Douvdevani, PhD, Yoram Shapira, MD, Alan A. Artru, MD^||, Yuval Sufaro, MA, Julia Mazar, PhD, and Gad Shaked, MD

From the *Department of Plastic Surgery, Department of Surgery B and Trauma Unit, Department of Biochemistry, Laboratory Nephrology, Division of Anesthesiology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; ||Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington.

Address correspondence and reprint requests to Gad Shaked, MD, Department of Surgery B, Director of Trauma Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheva 84101, Israel. Address e-mail to shakedg{at}bgumail.bgu.ac.il.

Ketamine was reported to decrease cytokine production and improve survival after Escherichia coli-induced sepsis. We examined whether ketamine decreased interleukin (IL)-6 production and improved survival after 1) burn injury or 2) burn injury combined with sepsis (E. coli) at 24 h. Ketamine (10 mg/kg) or saline was given at 1 h after burn injury (G 1, 2, 5, 6), 24 h after burn injury (G 3, 4), or at E. coli inoculation (G 7, 8). Mortality was recorded for 7 days and IL-6 was measured in serum at 6 h after burn (G 1–2), 30 h after burn (G 3–4), or 6 h after sepsis (30 h after burn) (G 5–8). Burn injury only: Ketamine given immediately (1 h) after burn injury but not 24 h after, decreased the burn-induced increase of IL-6 but did not improve survival. Burn injury + sepsis: Ketamine given immediately after burn injury did not significantly decrease the sepsis-induced increase of IL-6 or improve survival. In contrast, ketamine given immediately after sepsis significantly improved survival (46.1% versus 13.3%, P = 0.008) and decreased IL-6 production (72,640 ± 40,990 vs 332,300 ± 32,300 pg/mL, P = 0.008). We conclude that ketamine therapy improves survival in burn injury followed by sepsis. This beneficial effect is probably achieved through interference with the inflammatory cascade, as evidenced by attenuation of the proinflammatory marker IL-6.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999