[Ketamine for subarachnoid anesthesia during hypovolemia: preliminary study in pigs]

To assess whether subarachnoid ketamine has fewer hemodynamic effects than lidocaine in normal and hypovolemic pigs and to determine whether or not the effects of ketamine are dose-dependent.

Thirty pigs were randomly allocated to receive subarachnoid administration of lidocaine 2 mg x kg(-1), ketamine 1 mg x kg(-1) or ketamine 2 mg x kg(-1), in a situation of either normal or reduced blood volume. The pigs were assigned to six groups: group L2 (2% lidocaine 2 mg x kg(-1), normovolemia), group L2H (2% lidocaine 2 mg x kg(-1), hypovolemia), group K1 (ketamine 1 mg x kg(-1), normovolemia), group K1H (ketamine 1 mg x kg(-1), hypovolemia), group K2 (ketamine 2 mg.kg(-', normovolemia), and group K2H (ketamine 2 mg x kg(-1), hypovolemia). To induce hypovolemia 30% of the calculated blood volume was withdrawn from each pig. The subarachnoid space was catheterized, and invasive measurements of hemodynamic variables (derived from arterial, central venous and pulmonary artery catheter monitoring) were obtained. Variables were recorded at baseline and 5 and 15 min after drug injection in the normovolemic groups, and at baseline after inducing hypovolemia and 5 and 15 min after drug injection in the hypovolemic groups.

In the normovolemic pigs no significant differences were detected between groups. In hypovolemic pigs differences were observed in heart rate and arterial pressure between the ketamine 1 mg x kg(-1) and lidocaine 2 mg x kg(-1) groups (P < 0.05). The decreases in heart rate and arterial pressure were less marked in the ketamine group. Mixed venous oxygen saturation and cardiac index deteriorated to a lesser degree in both ketamine groups than in the lidocaine groups (P < 0.05).

Racemic ketamine administered by subarachnoid injection in hypovolemic pigs produces less deterioration in hemodynamic variables than does lidocaine. Hemodynamic changes caused by ketamine were not dose-dependent. These findings may be of interest, given the increased use of ketamine in neuroaxial anesthesia and analgesia and perhaps the possible use of neuroaxial ketamine in hypovolemic patients.