Evaluation of the neuroprotective effects of S(+)-ketamine during open-heart surgery.
We compared the effect of S(+)-ketamine to remifentanil, both in combination with propofol, on the neurocognitive outcome after open-heart surgery in 106 patients. A battery of neurocognitive tests was administered before surgery and 1 and 10 wk after surgery. Fourteen patients (25%) in the control group and 10 patients (20%) in the S(+)-ketamine group had 2 or more tests with a cognitive deficit (decline by at least one preoperative SD of that test in all patients) 10 wk after surgery (P = 0.54). Z-scores were calculated for all tests. No significantly better performance could be detected in the S(+)-ketamine group, except for the Trailmaking B test 10 wk after surgery. We conclude that S(+)-ketamine offers no greater neuroprotection compared with remifentanil during open-heart surgery.


CONCLUSIONS
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.
Nagels
W
W
Departments of *Anesthesiology, †Neuropsychology, and ‡Laboratory Medicine, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium.
Demeyere
R
R
Van Hemelrijck
J
J
Vandenbussche
E
E
Gijbels
K
K
Vandermeersch
E
E
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods*; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006801:Humans; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000494:pharmacology / Q000627:therapeutic use*; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy* / Q000523:psychology; D010880:Piperidines / Q000494:pharmacology / Q000627:therapeutic use; D015742:Propofol / Q000494:pharmacology / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil
D018696:Neuroprotective Agents; D010880:Piperidines; D007649:Ketamine; D000077208:Remifentanil; D015742:Propofol