USE OF POSTOPERATIVE KETAMINE INFUSION FOR CEREBRAL PROTECTION IN CHILDREN IN CARDIAC SURGERY

Highlights The presented study is relevant due to high incidence of cognitive impairment during cardiac surgery in children. The article describes and proves the effectiveness of a cerebral protection strategy using ketamine infusion in subanesthetic doses. Abstract Aim. To assess the effectiveness of ketamine infusion in the postoperative period for neuroprotection in children during surgical correction of congenital septal heart defects. Methods. The study included 68 patients aged from 1 to 60 months and weighing from 3.9 to 19.5 kg who underwent correction of atrial or ventricular septal defect with cardiopulmonary bypass. All subjects were randomized into three groups: patients in the study group-1 (SG-1) received ketamine infusion after the completion of surgery and for the next 16 hours at a dose of 0.1 mg/kg/hour; patients in study group-2 (SG-2) received ketamine at a dose of 0.2 mg/kg/hour, and patients in the control group (CG) did not receive ketamine. To analyze the severity of damage to the neurovascular unit, the following specific serum markers were used: S-100-ß, neuron-specific enolase, glial fibrillary acidic protein, occludin and claudin-1. Blood for analysis of marker concentrations was collected at 3 control points: 1 – before the start of the operation, 2 – immediately after completion of cardiopulmonary bypass, 3 – 16 hours after the operation. Results. The groups were comparable in terms of pre- and intraoperative characteristics. S-100-ß protein in patients who received 0.1 mg/kg/hour ketamine did not differ from controls, but patients who received 0.2 mg/kg/hour ketamine showed statistically significant differences compared to the group with lower concentrations. Neurospecific enolase had lower concentrations in both study groups compared to the controls. Occludin showed a significantly lower concentration only in the group with a ketamine dose of 0.2 mg/kg/hour. Glial fibrillary acidic protein and claudin-1 concentrations did not differ between groups. Conclusions. The study results showed the effectiveness of using ketamine infusion at a dose of 0.1 and 0.2 mg/kg/hour for cerebral protection in children in the postoperative period of correction of congenital septal heart defects. Moreover, they proved that a ketamine dose of 0.2 mg/kg/hour has a more pronounced neuroprotective effect.