Ketamine as a neuroprotective and anti-inflammatory agent in children undergoing surgery on cardiopulmonary bypass: A pilot randomized, double-blind, placebo-controlled trial
Pediatric Critical Care,
Bhutta AT et al. – The authors did not find any evidence for neuroprotection or neurotoxicity in the pilot study. A large, adequately powered randomized control trial is needed to discern the central nervous system effect of ketamine on the developing brain. brain.Methods
- The authors randomized 24 infants, without chromosomal abnormalities, to receive ketamine (2mg/kg, n=13) or placebo (saline, n=11) before cardiopulmonary bypass for repair of ventricular septal defects.
- Plasma markers of inflammation and central nervous system injury were compared at the end of surgery, and 6, 24, and 48hrs after surgery.
- Magnetic resonance imaging and spectroscopy before cardiopulmonary bypass and at the time of hospital discharge were performed in a subset of cases and controls (n=5 in each group).
- Cerebral hemodynamics were monitored postoperatively using near–infrared spectroscopy, and neurodevelopmental outcomes were assessed using Bayley Scales of Infant Development–II before and 2–3wks after surgery.
- Statistically significant differences were noted in preoperative inspired oxygen levels, intraoperative cooling and postoperative temperature, respiratory rate, platelet count, and bicarbonate levels.
- The peak concentration of C–reactive protein was lower in cases compared to controls at 24hrs (p=.048) and 48hrs (p=.001).
- No significant differences were noted in the expression of various cytokines, chemokines, S100, and neuron–specific enolase between the cases and controls.
- Magnetic resonance imaging with spectroscopy studies showed that ketamine administration led to a significant decrease in choline and glutamate plus glutamine/creatine in frontal white matter.
- No statistically significant differences occurred between pre– and postoperative Bayley Scales of Infant Development–II scores.