S-Ketamine attenuates inflammatory effect and modulates the immune response in patients undergoing modified radical mastectomy: A prospective randomized controlled trial

Zhang, Junxia; Qian, Ma; Li, Wenbin; Li, Xiaohui

doi:10.3389/fphar.2023.1128924

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…Anesthesia with continuous infusion of esketamine after a single intravenous injection during elective coronary artery bypass graft (CABG) surgery decreases plasma proin ammatory cytokines (IL-6 and IL-8) and increases plasma IL-10 during and after cardiopulmonary bypass (26). Combined use of esketamine for induction and maintenance could also exert a systemic anti-in ammatory effects, and increase the absolute counts of CD3 + and CD4 + cells in patients at the end of and 24 h after modi ed radical mastectomy (27). Our present study further revealed potential anti-in ammatory effects of esketamine on secondary infectioninduced systemic in ammation and elucidated the mechanism of its anti-in ammatory effects by attenuating the downregulation of hippocampal BDNF through inhibiting the intestinal ora/subdiaphragmatic vagus nerve/spleen axis.…”

Section: Discussionmentioning

confidence: 99%

“…(R)-Ketamine is well established to exert protective effects in a variety of in ammatory diseases, including LPS-induced depression-like behaviors (21), ischaemic stroke (22), Parkinson's disease (23), and ulcerative colitis (24). Complementarily, esketamine also possesses antiin ammatory properties (25)(26)(27). Nonetheless, it remains unclear whether esketamine alleviates systemic in ammation and cognitive dysfunction in secondary LPS exposure-imitating secondary infection postrecovery from primary LPS injection-mediated endotoxaemia.…”

Section: Introductionmentioning

confidence: 99%

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Esketamine prevents cognitive deficiency via intestinal flora/subdiaphragmatic vagus nerve/spleen axis after a secondary LPS exposure

Wu,

Zhang,

Xie

et al. 2023

Preprint

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After resolution of primary infection, patients are susceptible to more severe secondary infection with unclear underlying mechanisms.To investigate whether esketamine treatment immediately after primary LPS exposure could alleviate second-infection-induced cognitive impairment. In this study, mice were injected intraperitoneally (i.p.) with lipopolysaccharides (LPS; 5 mg/kg) 10 days apart. Esketamine (10, 15 or 30 mg/kg) was i.p. injected immediately after the primary LPS injection. Splenectomy or subdiaphragmatic vagotomy (SDV) was performed 7 days before secondary LPS exposure or administration of antibiotics. Esketamine at 30 mg/kg mitigated splenomegaly at 3 and 10 days post primary LPS injection. It countered cognitive dysfunction and proinflammatory cytokine increases from secondary LPS exposure. Mice with splenectomy or SDV showed reduced proinflammatory cytokines, heightened hippocampal BDNF, and improved cognition after secondary infection, without added esketamine effect. FMT from esketamine-treated endotoxic mice to pseudo germ-free (PGF) mice attenuated hippocampal BDNF downregulation and cognitive dysfunction in PGF mice without splenectomy. FMT failed to reverse PGF mice's SDV-induced splenomegaly. Blocking BDNF signaling negated esketamine's ameliorating effects on secondary LPS-induced cognitive dysfunction. In conclusion, the intestinal flora/subdiaphragmatic vagus nerve/spleen axis-mediated downregulation of hippocampal BDNF had a profound effect on secondary LPS-induced inflammation and cognitive dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Esketamine prevents cognitive deficiency via intestinal flora/subdiaphragmatic vagus nerve/spleen axis after a secondary LPS exposure

Wu,

Zhang,

Xie

et al. 2023

Preprint

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“…A recent randomized controlled trial assessed the impact of three distinct doses of s-ketamine (0.25, 0.5, and 0.75 mg/kg at induction, followed by infusions of 0.25, 0.5, and 0.75 mg/kg/h, respectively) on immune-inflammatory function in patients undergoing modified radical mastectomy [92]. The data indicated that s-ketamine doses of 0.5 mg/kg and 0.75 mg/kg had a diminished impact on patients' cell-mediated immune function, resulting in a more attenuated inflammatory response.…”

Section: Clinical Studiesmentioning

confidence: 99%

Perioperative Ketamine and Cancer Recurrence: A Comprehensive Review

Rodriguez Arango,

Zec,

Khalife

2024

JCM

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Cancer is a significant global health threat and a leading cause of death worldwide. Effective early-stage interventions, particularly surgery, can potentially cure many solid tumors. However, the risk of postoperative cancer recurrence remains high. Recent research highlights the influence of perioperative anesthetic and analgesic choices on the fate of residual cancer cells, potentially affecting recurrence risks. Among these agents, ketamine—a well-known anesthetic and analgesic—has garnered interest due to its antitumor properties, mainly through inhibiting the N-methyl-D-aspartate (NMDA) receptor found in various cancer tissues. Additionally, ketamine’s potential immunomodulatory effects, given the expression of NMDA receptors on immune cells, suggest that it plays a significant role during the perioperative period. This review synthesizes current evidence on ketamine’s impact on cancer cell biology, inflammation, immune modulation, and the role of the gut microbiota, proposing ketamine as a promising agent for enhancing oncological outcomes.

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“…Esketamine, the s-enantiomer of ketamine, has more potent analgesic and sedative effects, particularly favorable sympathomimetic properties, with fewer adverse reactions than racemic ketamine [6,7]. It is now a popular medicine that is widely used in various areas [8], helps decrease propofol dosage, reduces the incidence of respiratory depression, stabilizes hemodynamics [9][10][11], and improves postoperative recovery quality [12][13][14]. Nevertheless, studies examining the e cacy and safety of the combination of esketamine and propofol for curative colorectal endoscopic resection are lacking.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of esketamine combined with propofol for curative endoscopic resection in colorectum: A prospective, randomized controlled trial

Ma,

Wang,

Yang

et al. 2023

Preprint

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Background Curative endoscopic resection is widely used to treat colonic polyps and early stage cancers. The anesthetic strategy commonly involves the use of propofol combined with a small dose of opioids for sedation. Adverse respiratory or cardiovascular events such as hypotension often occur when attempting to achieve the necessary level of sedation. Several studies have suggested its advantages owing to the anesthetic, analgesic, and sympathomimetic properties of esketamine. However, there are no reports on curative colorectal endoscopic resection. We designed this randomized controlled trial to assess the efficacy and safety of esketamine combined with propofol for sedation in patients undergoing curative colorectal endoscopic resection. Methods A total of 166 patients who underwent curative colorectal endoscopic resection were randomly assigned to groups A (propofol + fentanyl) or E (propofol + esketamine). Ideal sedation was assessed using the MOAA/S scale and was achieved using TCI-propofol with different doses of fentanyl and esketamine. The propofol consumption and vasoactive drug dosages were recorded. Sedation-related times, adverse events, and satisfaction were recorded. Results Of the 160 patients, the total propofol consumption was significantly lower in group E (n = 81) (300 mg) than in group A (n = 79) (350 mg). Hypotension and bradycardia were significantly lower in Group E than in Group A. The groups showed no significant differences in other adverse events, induction time, recovery time, or patient or endoscopist satisfaction. Conclusion Compared to fentanyl, esketamine helps decrease propofol consumption and increases cardiovascular stability during curative colorectal endoscopic resection in American Society of Anesthesiologists Class I–III patients without affecting anesthesia, patient and endoscopist satisfaction, or other adverse events. Trial registration The study was retrospectively registered at the Chinese Clinical Trial Registry (www.chictr.org.cn; registration number: ChiCTR2300069014 on 03/03/2023).

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S-Ketamine attenuates inflammatory effect and modulates the immune response in patients undergoing modified radical mastectomy: A prospective randomized controlled trial

Cited by 6 publications

References 27 publications

Esketamine prevents cognitive deficiency via intestinal flora/subdiaphragmatic vagus nerve/spleen axis after a secondary LPS exposure

Esketamine prevents cognitive deficiency via intestinal flora/subdiaphragmatic vagus nerve/spleen axis after a secondary LPS exposure

Perioperative Ketamine and Cancer Recurrence: A Comprehensive Review

Efficacy and safety of esketamine combined with propofol for curative endoscopic resection in colorectum: A prospective, randomized controlled trial

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