***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Attenuation of central sensitization with NMDA-active drugs such as S-Ketamine may play a role in postoperative analgesia and prevention of neuropathic pain . However , during cesarean section with neuraxial block , S-Ketamine might have adverse effects on the interaction between mothers and infants , including breastfeeding . METHODS Women undergoing elective repeat cesarean section with subarachnoid anesthesia ( 0.5 % hyperbaric bupivacaine 8 - 10 mg and sufentanil 5 μg ) were enrolled in a double-blind , r and omized study . Patients in the S-Ketamine group ( N.=28 ) received i.v . midazolam 0.02 mg/kg and S-Ketamine 0.5 mg/kg i.m . bolus 10 minutes after birth followed by a 2 μg/kg/min i.v . continuous infusion for 12 h. The  control group ( N.=28 )  received placebo . Paracetamol and patient controlled analgesia with intravenous morphine were given postoperatively . Von Frey filaments were used to assess pain threshold on the inner forearm and T10-T11 dermatomes ( supposed hyperalgesic area ) . RESULTS S-Ketamine  reduced morphine consumption at 4 - 8 , 8 - 12 , and 12 - 24 hours after surgery ( total 31 % ) , even after its effect has ceased , suggesting an anti-hyperalgesic action . Mild side effects were observed in the S-Ketamine group one hour after delivery . All side effects were rated as light and there were no serious adverse events . Pain threshold was not significantly different between groups . S-Ketamine patients showed a trend towards reduced pain sensitivity at the T10 dermatome , which is involved by surgical damage . After three years , patients reported no differences in residual pain , dysesthetic symptoms , or duration of breast-feeding . CONCLUSION Preventive administration of S-Ketamine via 12-hour infusion was safe and may have anti-hyperalgesic action after cesarean section Using the isolated arm technique , the frequency of awareness was evaluated in 50 full-term patients undergoing elective Caesarean section under general anaesthesia . In 20 patients , anaesthesia was induced with thiopentone 4 mg kg-1 , and in the other 30 patients , induction was with ketamine 1.5 mg kg-1 . Following suxamethonium 1.5 mg kg-1 and tracheal intubation , anaesthesia was supplemented during the induction-delivery period in the thiopentone group with 50 % nitrous oxide and 0.5 % halothane in oxygen in 10 patients , and with 1 % halothane in 100 % oxygen in the other 10 patients . In the ketamine group , the patients underwent ventilation with 50 % nitrous oxide and 0.5 % halothane in oxygen in 10 patients , with 1 % halothane in 100 % in 10 patients , and with 100 % oxygen only in the last 10 patients . Awareness was significantly greater after induction with thiopentone ( 14/20 ) than after ketamine ( 4/30 ) . There were no significant differences in Apgar scores or umbilical vein blood-gas values in the newborns At Baragwanath Hospital an average of 1200 Caesarean sections are performed annually . Until recently the most common induction agent employed in these cases has been thiopentone . This has not proved a satisfactory drug , on account of a high incidence of awareness during operation . The usefulness of ketamine in the obstetric patient is suggested by its rapid action , lack of respiratory and cardiovascular depression ' and profound analgesia2 and anaesthesia . We therefore compared ketamine with thiopentone with special reference to the occurrence of intra-operative awareness OBJECTIVE To compare the neonatal and maternal effects of propofol and ketamine as induction agents for elective cesarean section . DESIGN R and omized , double-blind study . SETTING Inpatient Obstetrics Department of Sappasitthiprasong Ubonratchatani Hospital , Ubonratchatani province , Thail and INTERVENTION 2 groups of 50 patients each receiving either 2 mg/kg propofol or 1 mg/kg ketamine for the induction of anesthesia . RESULTS The time from the induction to cord clamping ( I-C ) , the time from the uterine incision to cord clamping ( U-C ) , the hemodynamic changes , sleep ' quality , dream , recall , awareness , Postoperative nausea & vomiting ( PONV ) , and Apgar scores were studied In the ketamine group Systolic Blood Pressure and Diastolic Blood Pressure rose about 10 - 25 % of the baseline after the induction , intubation , skin incision , and cord clamping ( p < 0.001 ) while in the propofol group only the Heart Rate rose ( p < 0.036 ) after the induction , the intubation , the skin incision , and cord clamping . Apgar scores , the I-C time , the U-C time , the age , the weight and total amount of methergin and oxytocin were not significantly different in both groups . No incidence of awareness , nightmare and ketamine 's phychomimetic side effects was found The incidence of unpleasant light sleep , dreams and PONV was low . Most patients were willing to have the same anesthetic technique for the next cesarean section ( 81.3 % of the propofol group & 86 % of the ketamine group ) . CONCLUSION Both propofol and ketamine can be used as alternative induction agents to thiopental . The addition of sevoflurane immediately after the induction , together with the use of midazolam and morphine after delivery shall prevent awareness and ketamine 's phychomimetic side effects . However ketamine was cheaper and although Systolic Blood Pressure and Diastolic Blood Pressure were elevated they were within an acceptable range Ketamine ( 1 mg·kg-1 ) or thiopentone ( 4mg·kg-1 ) was used to induce anaesthesia for Caesarean section in 62 normotensive patients . During induction of anaesthesia and before laryngoscopy , blood pressure did not change in either group ( preinduction systolic blood pressure , 131 mmHg , and diastolic blood pressure , 75 mmHg ) . When laryngoscopy and intubation were performed , mean blood pressures of both patient groups increased 20–30 per cent . With ketamine ( n = 30 ) heart rate was unchanged from the preinduction rate of 85 beats/min before laryngoscopy and increased significantly by 15 per cent during laryngoscopy and intubation . With thiopentone ( n = 32 ) , heart rate increased significantly to 20 per cent above the preinduction rate of 87 beats/min during induction and increased further ( to 35 per cent above the preinduction rate ) during laryngoscopy and intubation . The average maximal rate-pressure product calculated for the thiopentone group was over 18,000 , which was significantly higher than the 15,000 calculated for the ketamine group . Neonatal outcome as assessed by Apgar score and umbilical blood gas analysis was good and did not differ significantly between groups . RésuméLa kétamine ( 1 mg·kg-1 ) ou le thiopentone ( 4 mg·kg-1 ) a été utilisé comme agent d’induction chez 62 patientes normotensives devant subir une césarienne . Lors de l’induction et avant la laryngoscopie , la tension artérielle n’a pas changé dans aucun des deux groupes ( la tension artérielle systolique après induction , 131 mmHg , et la pression artérielle diastolique , 75 mmHg ) . Lors de la laryngoscopie et l’intubation la tension artérielle dans les deux groupes augmenta de 20 à 30 pour cent . Avec la ketamine ( n = 30 ) la fréquence cardiaque qui était de 85 battements/min . avant l’induction n’a pas changée lors que l’induction et avant la laryngoscopie . Cependant on observa une augmentation significative de 15 pour cent lors de la laryngoscopie et l’intubation . Avec le thiopentone ( n = 32 ) la fréquence cardiaque qui était de 87 battements/min . avant l’induction augmenta significa-tivement de 20 pour cent lors de l’induction et avant la laryngoscopie . Cette augmentation de la fréquence cardiaque atteint 35 pour cent lors de la laryngoscopie et l’intubation . Le produit de la fréquence cardiaque par la pression maximale moyenne , calculé pour le groupe thiopentone était supérieur à 18,000 , significativement supérieur à celui du groupe kétamine calculé à 15,000 . Concernant les nouveaux-nés évalués par les tests d’Apgar et l’analyse des gaz sanguins du cordon ombilical le résultat final était considéré bon et n’a pas différé significativement entre les deux groupes Background Suitable analgesia after cesarean section helps mothers to be more comfortable and increases their mobility and ability to take better care of their infants . Objectives Pain relief properties of ketamine prescription were assessed in women with elective cesarean section who underwent spinal anesthesia with low dose intravenous ketamine and midazolam and intravenous midazolam alone . Patients and Methods Sixty pregnant women scheduled for spinal anesthesia for cesarean section were r and omized into two study groups . Ketamine ( 30 mg ) + midazolam ( 1 mg = 2CC ) or 1 mg midazolam ( 2CC ) alone , was given immediately after spinal anesthesia . Pain scores at first , second and third hours after CS operation , analgesic requirement and drug adverse effects were recorded in all patients . Results Ketamine group had significant pain relief properties in compare with control group in first hours after cesarean section ( 0.78 ± 1.09 vs. 1.72 ± 1.22 , VAS score , P = 0.00 ) . Total dose of meperidine consumption in women of ketamine group was significantly lower than women of control group ( 54.17 ± 12.86 vs. 74.44 ± 33.82 mg , P = 0.02 ) . There were no significant drug side effects in participated patients . Conclusions Intravenous low-dose ketamine combined with midazolam for sedation during spinal anesthesia for elective Caesarean section provides more effective and long lasting pain relief than control group STUDY OBJECTIVE To compare the efficacy and safety of ketamine 0.25 mg/kg with ketamine 0.5 mg/kg to prevent shivering in patients undergoing Cesarean delivery . DESIGN Prospect i ve , r and omized , double-blinded , placebo-controlled study . SETTING Operating rooms and postoperative recovery rooms . PATIENTS 120 ASA physical status 1 and 2 pregnant women scheduled for Cesarean delivery during spinal anesthesia .  MEASUREMENTS Patient characteristics , anesthetic and surgical details , Apgar scores at 1 and 5 minutes , and side effects of the study drugs were recorded . Heart rate , mean arterial pressure , oxygen saturation via pulse oximetry , tympanic temperature , severity of shivering , and degree of sedation  were recorded before intrathecal injection and thereafter every 5 minutes . Patients were r and omized to three groups : saline ( Group C , n=30 ) , intravenous ( IV ) ketamine 0.25 mg/kg ( Group K-0.25 , n=30 ) , or IV ketamine 0.5 mg/kg ( Group K-0.5 , n=30 ) . Grade 3 or 4 shivering was treated with IV meperidine 25 mg and the prophylaxis was regarded as ineffective . MAIN RESULTS The number of shivering patients was significantly less in Group K-0.25 and in Group K-0.5 than in Group C ( P = 0.001 , P = 0.001 , respectively ) . The tympanic temperature values of Group C were lower at all times of the study than in either ketamine group . Median sedation scores of Group K-0.5 were significantly higher than in Group K-0.25 or Group C at 10 , 20 , 30 , and 40 minutes after spinal anesthesia . CONCLUSIONS Prophylactic IV ketamine 0.25 mg/kg was as effective as IV ketamine 0.5 mg/kg in preventing shivering in patients undergoing Cesarean section during spinal anesthesia BACKGROUND The aim of this study was to evaluate the benefit of a combination of thiopentone and ketamine over either of these drugs alone as an induction agent for Cesarean section . METHODS R and omized prospect i ve study of 3 groups of 20 patients ( Group I : thiopentone alone ; Group II : ketamine alone ; Group III thiopentone and ketamine combination ) . RESULTS Systolic blood pressure ( BP ) ( as measured at baseline , after induction , at intubation , and at 5 min , 10 min , 15 min , 20 min 
    Output:
    
Significant differences in the aforementioned outcome variables were found only in the spinal anaesthesia studies .
No differences were observed for maternal nausea , vomiting , pruritus , and psychomimetic effects .
We conclude that ketamine enhances post-operative analgesia after caesarean section under spinal anaesthesia .
There is a paucity of data for several maternal adverse effects as well as for neonatal well-being .