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 Medicine, 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.
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.
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