Effects of intraoperative intravenous administration of analgesic dose of Ketamine during spinal anesthesia for cesarean section

Background and objectives: The most common anesthetic technique in the cesarean section is spinal anesthesia. Our objectives were to identify the patient’s status by the use of analgesic dose of ketamine given intravenously during the first hour of spinal anesthesia for cesarean section operation. Methods: This case control study was performed on 100 full term pregnant ladies, undergoing elective cesarean section by spinal anesthesia, in Erbil Maternity Teaching Hospital between the period of May 2021 until October 2021. Randomly 50% of them selected to give ketamine in an analgesic dose (0.35 mg/kg IV). Arterial blood pressure, heart rate, intra operative nausea and vomiting, peripheral capillary oxygen saturation, hallucination, shivering and anxiety were checked at 5 minutes before the spinal injection, and every 5 minutes interval after the injection. The use of ephedrine, rescue antiemetics was written. Results: Mean arterial pressure in selected group where ketamine was used was significantly higher p<0.001 (100.3±13.9mmHg) with a more stable heart rate compared to that in the control group (99.4±15.4mmHg). Statistically significant (p<0.001) less ephedrine (total dose) used in the ketamine group (6 patients versus 39 patients in control group) as well as rescue antiemetics (2 versus 9, p=0.025). Shivering (p>0.999), and anxiety (p=0.102) had no statistically significant difference between the two groups. Conclusion: Analgesic dose of ketamine intravenously can be beneficial in inhibiting hypotension after spinal anesthesia (less need for vasoconstrictors) and less intraoperative nausea and vomiting in parturient undergoing cesarean section.