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CARDIOVASCULAR ANESTHESIA

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

W. Nagels, MD^*, R. Demeyere, MD, PhD^*, J. Van Hemelrijck, MD, PhD^*, E. Vandenbussche, MD, PhD, K. Gijbels, MD, PhD, and E. Vandermeersch, MD, PhD^*

Departments of *Anesthesiology, Neuropsychology, and Laboratory Medicine, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium

Address correspondence and reprint requests to Nagels Werner, MD, Department of Anesthesiology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium. Address e-mail to werner.nagels{at}skynet.be

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.

IMPLICATIONS: 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.

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