The gut in systemic inflammatory response syndrome and sepsis. Enzyme systems fighting multiple organ failure

Eur Surg Res. 2008;40(2):184-9. doi: 10.1159/000110859. Epub 2007 Nov 12.


The prognosis and care of critically ill ICU patients has improved over recent years, but the development of multiple organ failure (MOF) continues to cause significant morbidity and mortality. Shock, with resultant organ ischemia, appears to play a critical role in the development of MOF. It is our global hypothesis that MOF is a gut-derived phenomenon and that novel interventions can improve outcome in shock-induced gut inflammation and dysfunction in critically ill patients. We have found that the anesthetic agent ketamine has a profound impact on the response to endotoxic shock. This review summarizes our findings on the mechanisms of action by which ketamine is able to modulate the nitric oxide, cyclo-oxygenase and heme-oxygenase enzyme systems to attenuate endotoxin-induced organ dysfunction.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Anesthetics, Dissociative / pharmacology
  • Animals
  • Gastrointestinal Tract / enzymology*
  • Heme Oxygenase (Decyclizing) / metabolism
  • Infections / complications*
  • Infections / enzymology
  • Ketamine / pharmacology
  • Lipopolysaccharides / pharmacology
  • Multiple Organ Failure / chemically induced
  • Multiple Organ Failure / etiology*
  • Multiple Organ Failure / prevention & control*
  • Nitric Oxide Synthase / metabolism
  • Prostaglandin-Endoperoxide Synthases / metabolism
  • Systemic Inflammatory Response Syndrome / complications*
  • Systemic Inflammatory Response Syndrome / enzymology


  • Anesthetics, Dissociative
  • Lipopolysaccharides
  • Ketamine
  • Nitric Oxide Synthase
  • Heme Oxygenase (Decyclizing)
  • Prostaglandin-Endoperoxide Synthases