engleski

Effects of ketamine on the coagulation response during and after cardiopulmonary bypass: a prospective, randomized, double-blind controlled study

INTRODUCTION. The inflammatory response and the coagulation-fibrinolytic cascades are closely interconnected. Vascular injury following cardiopulmonary bypass (CPB) may result in uncontrolled platelet activation, thrombin generation, and disseminated intravacular coagulation. Many of the anesthetic agents posses immunomodulatory effects. The clinical implications of such effects in the context of CPB remain unknown. Ketamine attenuates IL-6 response and production of the superoxide anion by neutrophils after CPB, and reduces coronary uptake of neutrophils following myocardial ishemia and reperfusion (1). We studied the effect of small dose ketamine on the coagulation response (antithrombin III, fibrinogen, D-dimers, platelets) during and after CPB. METHODS. In the preliminary prospective study report, we randomized 25 patients underwent coronary artery bypass graft surgery in two groups: K-group (n=11), which received 0, 25 mg/kg ketamine, and P-group (n=14), which received placebo. Serum samples were collected before starting operation (T0), after aorta clamp releasing (T1), 30 min (T2), 2 (T3), 6 (T4), 12 (T5), 24 (T6), and 48 hours (T7) after weaning from CPB. Data (mean±SD) were done by variance analysis. RESULTS. Both group were comparable for age, sex, body surface area, and MODS score. Differences of operative (CPB and aorta cross-clamping time), and postoperative date (hemodynamic and ventilatory support, ICU stay, blood transfusion) between groups were not significant. CONCLUSION. In this preliminary study the findings suggest that, small dose of ketamine posses any effect on the coagulation response during and after CPB.

Ketamine; inflammatory response; heart surgery

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