Anesthetic Technique (Sufentanil Versus Ketamine Plus Midazolam) and Quantitative Electroencephalographic Changes After Cardiac Surgery

Abstract

Objectives: Cardiac surgery involving cardiopulmonary bypass is associated with neurologic deterioration. Several interventions, including anesthetic techniques, have been designed to limit ischemic brain damage and have been evaluated in animals. Markers of neurologic injury may facilitate the assessment of these interventions in humans.Design: A blinded randomized prospective study comparing 2 anesthetic techniques (one sufentanilbased, the other ketamine and midazolam-based) in patients undergoing cardiac surgery. Quantitative electroencephalography was used to detect postoperative neurologic injury. Setting: Major teaching hospital.Participants: Forty-two patients aged 18 to 70 years undergoing cardiac surgery.Interventions: Patients were anesthetized with either a sufentanil-based or a ketamine and midazolambased technique for cardiac surgery with cardiopulmonary bypass. Quantitative electroencephalography was performed preoperatively as well as 5 to 6 days postoperatively. Measurements and Main Results:Quantitative electroencephalography outcome did not differ (p > 0.05) between the 2 groups. It showed significant deterioration between preoperative and postoperative assessments with a decrease in faster and an increase in slower frequencies. In addition, the alpha attenuation index decreased. This may reflect a decrease in alertness. Both the intergroup comparisons and the assessment of individual changes failed to reveal significant differences between the anesthetic techniques. The adjuvant use of isoflurane correlated with less deterioration of quantitative electroencephalographic variables. Conclusions:The use of either sufentanil-based or ketamine and midazolam-based anesthetic techniques for cardiac surgery with cardiopulmonary bypass had no effects on a marker of postoperative neurologic injury (ie, quantitative electroencephalography).THE MANIFESTATIONS of cerebral injury after cardiac surgery, to some extent ascribable to the effects of cardiopulmonary bypass (CPB), include postoperative delirium, stroke, and cognitive changes.

Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

“…[ 37 ] Finally, one study examined postoperative quantitative electroencephalogram (EEG) (as a surrogate for brain dysfunction), one study examined postoperative ventricular arrhythmias, and one study examined neutrophil activation after surgery. [ 38 39 40 ] In these studies ketamine had no effect on postoperative EEG, it decreased the incidence of ventricular arrhythmias, and it decreased neutrophil activation.…”

Brain damages in ketamine addicts as revealed by magnetic resonance imaging

“…Ketamine employed in prescribed medical conditions had its advantages as it did not increase intracranial pressure during neurosurgery (Schmittner et al, 2007) and had no postoperative neurological damage when used in cardiopulmonary bypass patients (Smith et al, 2006). Medically, ketamine has also been proposed for anticonvulsive control (Dickenson and Ghandehari, 2007) and for controlling injury after stroke via it action on the glycine, zinc, and magnesium components of the glutamate binding sites (Collins et al, 1989); thus, protecting neuronal loss after stroke (Meldrum et al, 1987) and preventing of the spread of depolarization after injury (Hertle et al, 2012).…”

Tracking the effects of propofol, sevoflurane and (S)-ketamine anesthesia using an unscented Kalman filter-based neural mass model

“…The main function of sufentanil is analgesia, which can lead to increased amplitude and decreased frequency in EEG. Usually, EEG frequency declines to a delta rhythm under the effect of sufentanil, and the effect is correlated with the drug's dosage [66]. Therefore, the EEG we collected in the (S)-ketamine experiment was the combined effect of sufentanil and (S)-ketamine.…”