Immunomodulation by ketamine as an adjunct to total intravenous anesthesia in patients undergoing minimally invasive radical prostatectomy: A randomized pilot trial
Immunomodulation by ketamine as an adjunct to total intravenous anesthesia in patients undergoing minimally invasive radical prostatectomy: A randomized pilot trial
复制标题
DOI：
10.3892/mco.2020.2060
复制
发表时间：
2020-08-01
影响因子：
1.2
通讯作者：
Hirota, Kazuyoshi
中科院分区：
文献类型：
--
作者：
Kawaguchi, Jun;Ota, Daichi;Hirota, Kazuyoshi
术后免疫调节，包括自然杀伤细胞毒性（NKCC）降低，被认为是癌症手术后患者预后不良的预测因素。本研究探讨了在接受癌症手术的患者中通过氯胺酮作为麻醉辅助剂的直接免疫调节作用。本非双盲随机试验在广崎大学医院进行，60例患者接受了微创机器人根治性直肠癌切除术，以尽量减少由于手术压力引起的免疫调节。患者接受丙泊酚和瑞芬太尼全凭静脉麻醉，氯胺酮作为麻醉辅助剂（氯胺酮组）或不使用氯胺酮（对照组）。主要结局是这些组之间NKCC的差异。次要结果是嗜中性粒细胞-淋巴细胞比率（NLR）和白细胞介素（IL）-6，IL-1 β，IL-10和肿瘤坏死因子-α（TNF-α）水平的差异。NKCC和细胞因子在麻醉前（基线）和基线后6和24小时测量记录。在入院前最后一天和基线后48小时测定NLR。与各自的基线结果相比，各组在6 h时的NKCC值相似（基线对照，36.9 ± 15.6%; 6 h对照，38.3 ± 13.4%;基线氯胺酮，36.1 ± 17.0%; 6 h氯胺酮，36.6 +/- 16.4%），但在24 h显著降低（对照组，26.5 +/- 12.2%;氯胺酮，24.1 +/- 12.7%; P
Post-surgery immunomodulation, including reduced natural killer cell cytotoxicity (NKCC), is recognized as a predictor of poor outcomes in patients following cancer surgery. The present study investigated direct immunomodulation via ketamine as an anesthetic adjuvant in patients undergoing cancer surgery. The present non-double blinded randomized trial was conducted at Hirosaki University Hospital with 60 patients who underwent minimally invasive robotic radical prostatectomy to minimize the immunomodulation due to surgical stress. Patients received total intravenous anesthesia using propofol and remifentanil, with ketamine as an anesthetic adjuvant (the ketamine group) or without ketamine (the control group). The primary outcome was the difference in NKCC between these groups. The secondary outcomes were the differences in neutrophil-lymphocyte ratio (NLR) and levels of interleukin (IL)-6, IL-1 beta, IL-10 and tumor necrosis factor-alpha (TNF-alpha). NKCC and cytokines were measured before anesthesia (baseline) and at 6 and 24 h after baseline measurements were recorded. NLR was determined on the last day before admission and at 48 h post-baseline. NKCC values were similar in each group at 6 h when compared with respective baseline results (baseline control, 36.9 +/- 15.6%; 6 h control, 38.3 +/- 13.4%; baseline ketamine, 36.1 +/- 17.0%; 6 h ketamine, 36.6 +/- 16.4%) but significantly decreased at 24 h (control, 26.5 +/- 12.2%; ketamine, 24.1 +/- 12.7%; P