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CARDIOVASCULAR ANESTHESIA

S(+)-Ketamine, but Not R(-)-Ketamine, Reduces Postischemic Adherence of Neutrophils in the Coronary System of Isolated Guinea Pig Hearts

Andrea Szekely, MD^*, Bernhard Heindl, MD, Stefan Zahler, PhD, Peter F. Conzen, MD^*, and Bernhard F. Becker, MD, PhD

Institutes of *Anesthesiology and Physiology, Ludwig-Maximillians-University, Munich, Germany

Address correspondence and reprint requests to Dr. Bernhard F. Becker, Institute of Physiology, Pettenkoferstr 12, 80336 Munich, Germany.

Polymorphonuclear neutrophils (PMN) play a crucial role in the initiation of reperfusion injury. In a previous study, we found that ketamine reduced the postischemic adherence of PMN to the intact coronary system of isolated guinea pig hearts. Because ketamine is a racemic mixture (1:1) of two optical enantiomers, we looked for possible differences in action between the stereoisomers. Seventy-six guinea pig hearts were perfused in the "Langendorff" mode under conditions of constant flow (5 mL/min) using modified Krebs-Henseleit buffer. After 15 min of global warm ischemia, freshly isolated human PMN (10⁶) were infused as a bolus into the coronary system during the second minute of reperfusion. PMN adhesion was expressed as the numeric difference between PMN recovered in the effluent and those applied. Series A hearts received 5 µM S(+), 5 µM R(-), or 10 µM racemic ketamine starting 20 min before ischemia and during reperfusion. In Series B hearts, 10 µM nitro-L-arginine, an inhibitor of NO synthase, was added to the perfusate. In Series C, PMN were preincubated for 15 min with 5 µM S(+)- or R(-)-ketamine. Coronary vascular leak was assessed by measuring the rate of formation of transudate on the epicardial surface. Ischemia/reperfusion without anesthetics increased coronary PMN adherence from 25.5% ± 2.3% (basal) to 35.3% ± 1.5% of the number applied. S(+)-ketamine reduced postischemic adherence in each series (A, 25.5% ± 5.1%; B, 22.5% ± 1.7%; C, 25.3% ± 7.7%), as did racemate (A, 26.4% ± 3.7%). Although 5 µM R(-)-ketamine had no effect on adhesion (A, 30.5% ± 6.7%; B, 34.3% ± 5.1%; C, 34.3% ± 4.3%), it significantly increased vascular leak in the presence of NOLAG. These findings indicate stereoselective differences in biological action between the two ketamine isomers: S(+)-ketamine inhibited PMN adherence, R(-)-ketamine worsened coronary vascular leak in reperfused isolated hearts.

Implications: In this study, we demonstrated stereoselective differences in the biologic action of the two ketamine isomers in an animal model of myocardial ischemia. Polymorphonuclear neutrophil adherence to the coronary vasculature after ischemia was inhibited by S(+)-ketamine, whereas R(-)-ketamine increased coronary vascular fluid leak.

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