title: 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). High-sensitive 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 = 19, ketamine Group = 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 (p < 0.001). 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.
authors.affiliation: a Department of Anaesthesia , Türkiye Yüksek Ihtisas Education and Research Hospital , Ankara , Turkey .
authors.forename: Aslı
authors.initials: A
authors.lastname: Demir
authors.forename: Fatma Meric
authors.initials: FM
authors.lastname: Yılmaz
authors.forename: Cavit
authors.initials: C
authors.lastname: Ceylan
authors.forename: Omer Gokhan
authors.initials: OG
authors.lastname: Doluoglu
authors.forename: Perihan
authors.initials: P
authors.lastname: Uçar
authors.forename: Cevdet
authors.initials: C
authors.lastname: Züngün
authors.forename: Cigdem Yildirim
authors.initials: CY
authors.lastname: Guclu
authors.forename: Utku
authors.initials: U
authors.lastname: Ünal
authors.forename: Umit
authors.initials: U
authors.lastname: Karadeniz
authors.forename: Eren
authors.initials: E
authors.lastname: Günertem
authors.forename: Gokhan
authors.initials: G
authors.lastname: Lafci
authors.forename: Kerim
authors.initials: K
authors.lastname: Çağlı
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Özgök
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood*; D000368:Aged; D000777:Anesthetics / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D011183:Postoperative Complications; D000077208:Remifentanil; D020107:Troponin T / Q000097:blood
chemical_list: D000777:Anesthetics; D055316:Cystatin C; D010880:Piperidines; D020107:Troponin T; D007649:Ketamine; D003404:Creatinine; D000077208:Remifentanil
keywords: Acute kidney injury; anesthetics; coronary artery bypass; ketamine; remifentanil