Summary
The effects of ketamine anesthesia (3 mg/kg i.v.) on cardiovascular parameters and noradrenaline, adrenaline and dopamine-β-hydroxylase (DBH) activity in plasma were studied in 12 patients. At 3, 6 and 10 min after induction of anesthesia, a pronounced increase in heart rate (+28%) and in systolic and diastolic blood pressure (+28% and 17% resp.) was observed. Concomitantly noradrenaline and adrenaline concentrations increased significantly from 187 to 415 ng/l and from 97 to 271 ng/l, respectively. DBH-activity in plasma remained almost unchanged. From these results it can be concluded that the well known cardiovascular stimulant effect of ketamine is due to greatly enhanced sympatho-neuronal and sympatho-adrenal activity, presumably brought about by a central mechanism of action of the drug. Furthermore, DBH-activity in plasma appeared not to be a reliable index of sympathetic activity in man.
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Appel, E., Simrock, R., Palm, D., Wnuk, A., Dudziak, R.: Enhancement of sympatho-neuronal and sympatho-adrenal activity during ketamine anesthesia. Naunyn-Schmiedeberg's Arch. Pharmacol.297, R 236 (1977)
Axelrod, J., Tomchick, R.: Enzymatic O-methylation of epinephrine and other catechols. J. Biol. Chem.233, 702–705, (1958)
Badian, M., Appel, E., Palm, D., Rupp, W., Taeuber, K.: Acute increase of dopamine-β-hydroxylase activity (DBH) and catecholamines in human plasma during experimental stress. Pfluegers Arch.373, (Suppl.), R. 57 (1978)
Baraka, A., Harrison, T., Kachachi, T.: Catecholamine levels after ketamine anesthesia in man. Anesth. Analg. Current Res.52, 198–200 (1973)
Campbell, R.L.: Effect of atropine on the cardiovascular effects of ketamine HCl. J. Oral Surg.36, 351–355 (1978)
Chang, P.: The effects of ketamine on guinea pig heart. Br. J. Anaesth.45, 929–930 (1973)
Chang, P., Chan, K.E., Ganendran, A.: Cardiovascular effects of 2-(o-chlorophenyl)-2-methylaminocyclohexanone (CI-581) in rats. Br. J. Anaesth.41, 391–395 (1969)
Clanachan, A.S., Mc Grath, J.C.: Effects of ketamine on the peripheral autonomic nervous system of the rat. Br. J. Pharmacol.58, 247–252 (1976)
Constantin, B. Condat, P., Jourde, M., Condat, M., Lapallus, P.: Hypertension induite par la ketamine etude experimentale chez le chien. Ann. Anesthesiol. F.13, 473–480 (1972)
Domino, E.F., Chodoff, P., Corssen, G.: Pharmacological effects of CI-581, a new dissociative anesthetic, in man. Clin. Pharmacol. Ther. 6, 279–291 (1965)
Dowdy, E.G., Kaya, D.: Studies of the mechanism of the cardiovascular response to CI-581. Anaesthesiology29, 931–943 (1968)
Frankenhäuser, M., Dunnc, E., Lundberg, U.: Sex differences in sympathetic medullary reactions induced by different stressors. Psychopharmacology47, 1–5 (1976)
Geffen, L.: Serum dopamine-β-hydroxylase as an index of sympathetic function. Life Sci.14, 1593–1604 (1974)
Gemperle, M., Kreuscher, H., Langrehr, D. (eds.): Ketamine. Neue Ergebnisse in Forschung und Klinik. Anaesthesiology and Resuscitation69. Berlin-Heidelberg-New York: Springer 1973
Grzanna, R., Coyle, J.T.: Absence of a relationship between sympathetic neuronal activity and turnover of serum dopamine-β-hydroxylase. Naunyn-Schmiedeberg's Arch. Pharmacol.304, 231–236 (1978)
Hagenau, W., Pietsch, D., Arndt, J.O.: Der Effekt von Halothan und Enflurane sowie von Propanidid und Ketamin auf die Aktivität der Barorezeptoren des Aortenbogens decerebrierter Katzen. Anaesthesist25, 331–341 (1976)
Hensel, I., Braun, U., Kettler, D., Knoll, D., Martel, J., Paschen, K., Bretschneider, H.J.: Tierexperimentelle Untersuchungen zur Frage der Katecholaminaktivität unter Ketaminnarkose. In: Ketamin. Neue Ergebnisse in Forschung und Klinik. M. Gemperle, H. Kreuscher, D. Langrehr (eds.) Anaesthesiology and Resuscitation69, pp. 63–76. Berlin-Heidelberg-New York: Springer 1973
Holtz, P., Palm, D.: Brenzkatechine und andere sympathicomimetische Amine. Ergeb. Physiol.58, 1–580 (1966)
Kreuscher, H., Gauch, H.: The effect of the phenciclidine derivative Ketamine (CI-581) on the human vascular system. Anaesthesist16, 229–308 (1967)
Lanning, C.F., Harmel, M.H.: Ketamine Anesthesia. Ann. Rev. Med.26, 137–141 (1975)
Lundy, P.M., Gowdy, C.W., Colhoun, E.H.: Further experimental evidence of smooth muscle depressant effect of ketamine. Arch. Int. Pharmacodyn. Ther.216, 57–62 (1975)
Matsuki, A., Zsigmond, E.K., Kelsch, R.C., Kothary, S.P.: The effect of pancuronium bromide on plasma norepinephrine concentrations during ketamine induction. Can. Anaesth. Soc. J.21, 315–319 (1974)
Miletich, D.J., Ivan Koric, A.D., Albrecht, R.F., Zahed, B., Ilahi, A.A.: The effect of ketamine on catecholamine metabolism in isolated perfused rat heart. Anaesthesiology39, 271–277 (1973)
Montel, H., Starke, K., Görlitz, B.-D., Schümann, H.J.: Tierexperimentelle Untersuchungen zur Wirkung des Ketamins auf periphere sympathische Nerven. Anaesthesis22, 111–116 (1973)
Nedergaard, O.A.: Cocain like effects of ketamine on vascular adrenergic neurones. Eur. J. Pharmacol.23, 153–161 (1973)
Palm, D., Appel, E., Grobecker, H., Planz, G., Wiethold, G., Simrock, R., Bühring, M., Böhmer, G.: Dopamine-β-hydroxylase activity in plasma as an index of increasing sympathetic activity in man. Abstr. 6th Int. Congr. Pharmacol. Helsinki, p. 490 (1975)
Passon, P.G., Peuler, J.D.: A simplified radiometric assay for plasma norepinephrine and epinephrine. Analyt. Biochem.51, 618–631 (1973)
Peter, K., Altstaedt, F., Hollmann, G., Klose, R., Mayr, J.: Verhalten der Katecholaminspiegel im Blut während intravenöser Narkose mit Ketamin beim Hund. In: M. Gemperle, H. Kreuscher, D. Langrehr (Eds.): Ketamin. Neue Ergebnisse in Forschung und Klinik. Anaesthesiologie Resuscitation69, pp. 59–76. Berlin-Heidelberg-New York: Springer 1973
Planz, G., Palm, D.: Acute enhancement of dopamine-β-hydroxylase activity in human plasma after maximum work load. Eur. J. Clin. Pharmacol.5, 255–258 (1973)
Planz, G., Wiethold, G., Appel, E., Böhmer, D., Palm, D., Grobecker, H.: Correlation between increased dopamine-β-hydroxylase activity and catecholamine concentration in plasma. Determination of acute changes in sympathetic activity. Eur. J. Clin. Pharmacol.8, 181–188 (1975)
Rust, M., Landauer, B., Kolb, E.: Stellenwert von Ketamin in der Notfallsituation. Anaesthesis27, 205–212 (1978)
Schwartz, D. A., Horwitz, L. D.: Effects of ketamine on left ventricular performance. J. Pharmacol. Exp. Ther.194, 410–414 (1975)
Takki, S., Nikki, P., Jäätelä, A., Tammisto, T.: Ketamine and plasma catecholamines. Br. J. Anaesth.44, 1318–1322 (1972)
Tanaka, K., Pettinger, W. A.: Renin release and cardiovascular stimulation in the rat. J. Pharmacol. Exp. Ther.188, 229–233 (1974)
Traber, D. L., Wilson, R. D.: Involvement of the sympathetic nervous system in the pressor response to ketamine. Anaesth. Analg. Curr. Res.48, 248–252 (1969)
Traber, D. L., Wilson, R. D., Priano, L. L.: A detailed study of the cardiopulmonary response to ketamine and its blockade by atropine. South. Med. J.63, 1077–1081 (1970a)
Traber, D. L., Wilson, R. D., Priano, L. L.: Blockade of the hypertensive response to ketamine. Anesth. Analg.49, 420–426 (1970b)
Tweed, W. A., Mymin, D.: Myocardial force-velocity relations during ketamine anesthesia at constant heart rate. Anesthesiology41, 49–52 (1974)
Virtue, R. W., Alanis, J. M., Mori, M., Lafargue, R. T., Vogel, J. H. K., Metcalf, D. R. An anesthetic agent: 2-orthochlorophenyl-2-methylamino cyclohexanone HCl (CI-581). Anesthesiology28, 823–833 (1967)
Weinshilboum, R., Axelrod, J.: Serum dopamine-β-hydroxylase activity. Circ. Res.28, 307–315 (1971)
Zsigmond, K., Kelsch, R. C.: Elevated plasma norepinephrine concentrations during ketamine anesthesia. Clin. Pharmacol. Ther. (Abstr.)14, 149–150 (1973)
Zsigmond, E. K., Kelsch, R. C., Kothary, S. P., Vadnay, L.: Free norepinephrine concentrations during induction of anesthesia with ketamine. Rev. Brasil. Anesth.22, 443–451 (1972)
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The study was supported by a grant from the Deutsche Forschungsgemeinschaft.
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Appel, E., Dudziak, R., Palm, D. et al. Sympathoneuronal and sympathoadrenal activation during ketamine anesthesia. Eur J Clin Pharmacol 16, 91–95 (1979). https://doi.org/10.1007/BF00563113
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DOI: https://doi.org/10.1007/BF00563113