Evaluation of the Neuroprotective Effects of S(+)-Ketamine During Open-Heart Surgery

Abstract

N-methyl-D-aspartic acid receptors play an important role during ischemic brain injury. We could not demonstrate that S(+)-ketamine resulted in greater neuroprotective effects compared with remifentanil during cardiopulmonary bypass procedures when both were combined with propofol.

The Effect of Ketamine on Intracranial and Cerebral Perfusion Pressure and Health Outcomes: A Systematic Review

“…We reviewed the full texts of 192 articles, of which 10 met inclusion criteria. [18][19][20][21][22][23][24][25][26][27] Five randomized trials reported data on 854 patients, [19][20][21]24,25 and 5 prospective controlled studies reported data on 99 patients. 18,22,23,26,27 Tables 1 and 2 CPP, cerebral perfusion pressure.…”

“…population of undifferentiated critically ill patients including trauma patients, 21 and one with elective heart surgery patients. 25 Of the 5 prospective controlled studies, 3 were conducted with traumatic brain injury patients, 18,22,26 of which 2 were with patients with severe traumatic brain injury (GCS score <8) 18,26 and 1 was with patients with minor and severe brain injuries (GCS score 3 to 15). 22 Two studies enrolled patients undergoing neurosurgical interventions for either space-occupying lesions or obstructive hydrocephalus, 27 or for space-occupying lesions or nontraumatic subarachnoid hemorrhage.…”

“…20 Two of 5 trials were thought to be at high risk of selection bias because the methods for random sequence generation and allocation concealment were inadequately described. 24,25 Three trials, among them the largest multicenter trial that we included, were assigned Jadad scores of 2 25 and 3 19,21 because they were not double blinded and therefore were at high risk of performance bias. In 2 of these trials, the patients and outcomes assessors were blinded, but not the care providers.…”

“…In 2 of these trials, the patients and outcomes assessors were blinded, but not the care providers. 21,25 All trials were deemed to be at low risk of detection bias for the outcomes of intracranial and cerebral perfusion pressures, ICU length of stay, and mortality despite inadequate blinding because these measures are objective and easily quantifiable. [19][20][21]24,25 Three trials reported the results of neuropsychometric tests and GCS score as secondary outcomes.…”

Anestésicos, precondicionamento e proteção cerebral

“…Nevertheless, high-dose ketamine has neuroprotective effects on cortical ischemia in vivo [123][124] . Ketamine was similar to remifentanil in a randomized controlled trial comparing the neuroprotective effi cacy in open-heart surgery in combination with propofol 125 . The vasodilatory effect of ketamine may increase emboli movement, an event that could reduce its neuroprotective effect.…”