- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03793075
Ketamine Versus Propofol Effect on the Immune-mediatory Response for Abdominal Surgery
Immune-mediatory Response of Intravenous Ketamine Versus Propofol for Major Abdominal Surgeries: a Prospective Randomized Study
Host systemic responses to vigorous stimuli as trauma, surgical tissue injury, anesthesia and post-operative pain, leads to release a variety of pro-inflammatory cytokines including interleukin-1 (IL-1) and interleukin-6 (IL-6) mainly from monocytes and macrophages Thus, the rise of IL-6 is regarded as an early marker of tissue damage and its rise proportional to the degree of tissue damage .
It has been demonstrated that systemic responses to stress may be modified by the anesthetic technique used . Total intravenous anesthesia (TIVA) especially propofol based greatly suppresses the stress response induced by surgery when compared to inhalation by lowering cortisol levels.
Ketamine has the ability to modulate (modify) inflammation . Even the sub-anesthetic doses of ketamine in animal models were even provided to have an effect on the inflammatory response system in the central nervous system
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The release a variety of pro-inflammatory cytokines including tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) mainly from monocytes and macrophages due to surgical trauma or anesthesia .
IL-6 is constantly found in the peripheral blood and rapidly within few minutes unlike other pro inflammatory mediators. Thus, the rise of IL-6 is regarded as an early marker of tissue damage and IL-6 levels are proportional to the degree of tissue damage . The two major actions of IL-6 are having a key role in regulating stress responses by activating the hypothalamic-pituitary- adrenal (HPA) axis and synthesizing fibrinogen (which is necessary for the acute-phase response) serving as a growth factor for activated B-cells .
While appropriate inflammatory reactions are advantageous and essential for wound healing and host defense against microorganisms, excessive immune responses can be detrimental. The released mediators prompt systemic endocrine, immunological and metabolic responses result in increased pain sensitivity, altered metabolism, hyperthermia and greater secretion of liver acute phase proteins and stress hormones, so yields unstable patient's hemodynamic status
Propofol was documented to have an advantage in terms of inflammatory and immunomodulatory effects through significant effect on TNF-α, IL-6 and IL-10 release .
Ketamine has the ability to modulate (modify) inflammation and this is why it is recommended in patients with sepsis undergoing surgery . This may be possibly related with the variations in TNF-α and nuclear factor-κB expression . Even the sub-anesthetic doses of ketamine in animal models were even provided to have an effect on the inflammatory response system in the central nervous system which is involved in its therapeutic effect on depression (Yang-2 et al., 2013).
This study will be conducted to compare between the intravenous infusion of ketamine against the intravenous infusion of propofol during general anesthesia in patients undergoing major abdominal surgeries.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Elective major abdominal surgeries with median incision with right or left extension.
- ASA -physical status I -II
- aged from 18 till 70 years
Exclusion Criteria:
- body mass index more than 35 kg/m2,
- Patients having severe cardiovascular, respiratory, hepatic, renal, Endocrinol disorders, malignant
- Patients having chronic inflammatory diseases
- Patients received suppressant drugs in the 6 weeks before surgery.
- Any known allergy or any contraindications to anesthetic drugs;
- patient refusal,
- The usage of anti- emetic drug 24 hours before operation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Propofol group (P)
The maintenance of anesthesia , patient will receive sevoflurane 1%-2.5% with intravenous infusion of propofol 17 mcg /kg/min and 0.5 mg/kg fentanyl will be given if the heart rate or mean blood pressure increased by 30 % or more from the basal readings
|
propofol 17 mcg /kg/min
Other Names:
|
Active Comparator: Ketamine group ((K)
The maintenance of anesthesia , patient will receive sevoflurane 1%-2.5% with intravenous infusion of ketamine 5 mcg /kg/min and 0.5 mg/kg fentanyl will be given if the heart rate or mean blood pressure increased by 30 % or more from the basal readings
|
ketamine 5 mcg/kg/min will be used as intravenous anesthetic infusion
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Serum level of interleukin 6 (IL-6)
Time Frame: The time frame extend from 10 minutes before the induction of anesthesia till the first 24 hours postoperative
|
picogram/milliliter using ELISA techniques .Five measurement points : before the induction of general anesthesia, 30 min after beginning infusion of the anesthetic agent , then 2h, 8h and 24 hours postoperative.
|
The time frame extend from 10 minutes before the induction of anesthesia till the first 24 hours postoperative
|
Serum level of interleukin IL-1β (IL-1β)
Time Frame: The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
picogram/milliliter using ELSA techniques .Five measurement points : before the induction of general anesthesia, 30 min after beginning infusion of the anesthetic agent , then 2h, 8h and 24 hours postoperative.
|
The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Absolute neutrophil count
Time Frame: The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
Number multiplied by 1000/micro liter,measured before the induction of general anesthesia, 30 min after beginning infusion of the anesthetic agent , then 2h, 8h and 24 hours postoperative.
|
The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
Total leukocyte count
Time Frame: The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
Number multiplied by 1000/micro liter ,measured before the induction of general anesthesia, 30 min after beginning infusion of the anesthetic agent , then 2h, 8h and 24 hours postoperative.
|
The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
Neutrophil-lymphocyte ratio (N/L ratio)
Time Frame: The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
measured before the induction of general anesthesia, 30 min after beginning infusion of the anesthetic agent , then 2h, 8h and 24 hours postoperative.
|
The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
Serum Cortisol level
Time Frame: The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
micro-gram /deciliter by immunoassays techniques.measured
before the induction of general anesthesia, 30 min after beginning infusion of the anesthetic agent , then 2h, 8h and 24 hours postoperative.
|
The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
C-reactive protein serum level
Time Frame: The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
milgram/liter using ELISA technique.
measured before the induction of general anesthesia, 30 min after beginning infusion of the anesthetic agent , then 2h, 8h and 24 hours postoperative.
|
The time frame extend from 10 minutes before induction of anesthesia till the first 24 hours postoperative
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Reem Abdelraouf, lecturer, Mansoura University
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Dissociative
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Excitatory Amino Acid Antagonists
- Excitatory Amino Acid Agents
- Hypnotics and Sedatives
- Ketamine
- Propofol
Other Study ID Numbers
- R/18.09.287
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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