A comparison of the effects of ketamine and remifentanil on renal functions in coronary artery bypass graft surgery

Abstract

We have investigated the effects of ketamine-based and remifentanil-based anesthetic protocol on perioperative serum cystatin-C levels, and creatinine and/or cystatin-C-based eGFR equations in terms of acute kidney injury in coronary artery bypass graft (CABG) surgery. Using a simple randomization method (coin tossing), patients were divided into the two groups and not-blinded to the anesthetist. Remifentanil-midazolam-propofol or ketamine-midazolam-propofol-based anesthetic regimen was chosen. Different eGFR formulas using creatinine (MDRD, CKD-EPI, Cockrauft Gault); cystatin-C (eGFR1, eGFR2) or a combination of creatinine and cystatin-C (eGFR 3) were used to calculate estimated glomerular filtration rates (eGFRs). Highsensitive troponin T was used to determine if ketamine use in coronary surgery contributed to myocardial cell damage. Thirty-seven patients were included in the study (remifentanil group ¼ 19, ketamine Group ¼ 18). Urea, creatinine, cystatin-C levels were comparable between the groups in all the measurement times and also postoperative day 2 samples showed statistically higher results compared to baseline (p50.001). Effects of ketamine and remifentanil on renal functions were found similar. Creatinine and cystatin-C-based eGFR equations resulted similar in our study. Reversible stage 1 acute kidney injury (AKI) was observed on postoperative day 2 in seven patients from the remifentanil group and six patients from the ketamine group. Hs-troponin T was found to be higher in postoperative day 1 samples; there were no significant difference between the groups. Our results indicated that patients who have normal renal functions undergoing on-pump coronary bypass surgery, effects of ketamine and remifentanil on renal functions in terms of AKI were found to be similar.

Strategies for post–cardiac surgery acute kidney injury prevention: A network meta-analysis of randomized controlled trials

“…Studies that were not RCTs (n = 6), focused on surgical techniques or procedures (n = 23), or did not report the incidence of AKI-related outcomes or events (n = 28) were also excluded. Eight two-arm studies that could not connect to other studies in the network were also excluded (188)(189)(190)(191)(192)(193)(194). One study on the management of postoperative cardiogenic shock that compared vasopressin and norepinephrine, which was identified from a review article (6), was excluded for the same reason (195).…”

Evaluation of renal injury caused by acute volume replacement with hydroxyethyl starch 130/0.4 or Ringer's lactate solution in pigs

“…It has been reported that remifentanil and propofol itself, or combined with other drugs, may cause renal injury in healthy human patients [ 5 10 35 ]. Additionally, all pigs from all groups of our study were premedicated with azaperone, and this drug accumulates in pigs' kidneys and may also contribute to kidney damage [ 3 7 24 38 ].…”

“…TUNEL method relies on the presence of nicks in the DNA which may be identified by terminal deoxynucleotidyl transferase [ 10 ]. The number of animals studied was six in each group.…”

Renal effects of general anesthesia from old to recent studies

“…Besides this, high sensitive cardiac troponin T is associated with renal insufficiency in patients with a myocardial infraction (Huang et al, 2015). GFR levels in these patients were quite low after surgery when anesthetized with ketamine (Demir et al, 2015). Ketamine abuse, in the form of drugs, is also reported for hydronephrosis (Abuse, Tran, Nelson, Nogar, & Bramante, 2014;Nickolas et al, 2008), cystitis (Ho et al, 2010), and urinary tract dysfunction (Mason, Cottrell, Corrigan, Gillatt, & Mitchelmore, 2010) perhaps, the consequence of the high concentration of ketamine metabolites like hydroxyl norketamines in the urine (Chu et al, 2008).…”

“…It targets N-methyl-D-aspartate receptors and shows inhibitory effects (Garcia, Kolesky, & Jenkins, 2010). Renal effects of ketamine in patients who underwent cardiac surgery showed a rise in urea, creatinine sCyC, and high sensitive troponin T levels, postoperatively (Demir et al, 2015). Besides this, high sensitive cardiac troponin T is associated with renal insufficiency in patients with a myocardial infraction (Huang et al, 2015).…”