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We thank Drs. Hirata et al. for their interest in our work on the addition of low-dose ketamine to general anesthesia and make the following comments: 1) Although the authors claimed to use the same protocol as in our work, it is not clear to us whether matched controls were used, since their subjects were 20 patients undergoing unequal numbers of different operations. Without matched controls, of course, no conclusions can be drawn. 2) Their suggestion that the efficacy of ketamine on the cardiovascular response to surgery may depend on the length of skin incision is an interesting one. We do not know of any studies correlating length of incision with cardiovascular response, although O'Dwyer et al. [1] report differences in hospital stay and postoperative analgesic requirements in the same operation (cholecystectomy) performed through incisions of very different lengths (6 cm vs 15 cm). In this context, Hirata et al. do not mention the lengths of incisions in their patients or whether the lengths were standardized. However, they claim that their cases involved "more invasive surgery" than our open cholecystectomies but do not give criteria defining this greater "invasiveness.
